Improving the outcomes for people with diabetes undergoing surgery: An observational study of the Improving the Peri-operative Pathway of People with Diabetes (IP3D) intervention

Gerry Rayman; Emma Page; Steve Hodgson; William Henley; Tim Wr Briggs; William K Gray

doi:10.1016/j.diabres.2023.111062

Improving the outcomes for people with diabetes undergoing surgery: An observational study of the Improving the Peri-operative Pathway of People with Diabetes (IP3D) intervention

Diabetes Res Clin Pract. 2024 Jan:207:111062. doi: 10.1016/j.diabres.2023.111062. Epub 2023 Dec 16.

Authors

Gerry Rayman¹, Emma Page², Steve Hodgson³, William Henley⁴, Tim Wr Briggs⁵, William K Gray⁶

Affiliations

¹ Getting It Right First Time Programme, NHS England, London, UK; The Ipswich Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK; The Medical School, University of East Anglia, Norwich, UK.
² Getting It Right First Time Programme, NHS England, London, UK; The Ipswich Diabetes and Endocrine Centre, Ipswich Hospital, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK.
³ RSM UK Consulting LLP, Cambridge, UK.
⁴ Department of Health and Community Sciences, University of Exeter Medical School, Exeter, UK.
⁵ Getting It Right First Time Programme, NHS England, London, UK; Department of Surgery, Royal National Orthopaedic Hospital NHS Trust, Stanmore, London, UK.
⁶ Getting It Right First Time Programme, NHS England, London, UK. Electronic address: William.gray5@nhs.net.

PMID: 38110122
DOI: 10.1016/j.diabres.2023.111062

Abstract

Aims: We evaluated the effectiveness of an intervention to improve the care of people with diabetes undergoing surgery when implemented across multiple organisations.

Methods: This was an observational study using routinely collected data. Eight hospitals in England implemented the Improving the Peri-operative Pathway of People with Diabetes (IP3D) intervention, with pre-implementation data collected from 1st February to 31st July 2019 and post-implementation data collection within the period 1st February to 31st October 2021. Key elements were the use of a patient empowering peri-operative passport and the employment of a peri-operative diabetes specialist nurse. The primary outcome was the change in length of stay.

Results: In total 1837 patients at pre-implementation and 1164 patients at post-implementation undergoing elective surgery were included. Pre- and post-implementation 23.8 % and 33.4 % of patients had day-case surgery respectively. For in-patients median length of stay decreased from 3.2 days (inter-quartile range 1.5-6.1) pre-implementation to 2.5 days (inter-quartile range 1.4-5.4) post-implementation. There were also significant improvements in patient experience, hypo- and hyper-glycaemic events, wound complications and diabetes related complications.

Conclusions: The IP3D intervention has the potential to increase efficiency and reduce waiting lists for elective surgery on a nationwide basis.

Keywords: Diabetes; Perioperative care; Surgery.

Publication types

Observational Study

MeSH terms

Diabetes Mellitus* / surgery
England
Humans
Length of Stay