Development of a revised care pathway to reduce unscheduled care in adults with hypoglycaemia, relating to their diabetes

Abstract

Background: Diabetes is a complex, chronic condition that requires high levels of self-management. Achieving glycaemic control can be challenging, with individuals often experiencing acute complications such as hypoglycaemia and requiring clinical intervention by ambulance services. As the demand on health services continues to grow, reducing unscheduled hospital care, where appropriate, for these patients is important and aligns with government policy in the UK and Ireland. Understanding the factors that influence clinical decision-making and conveyance to hospital by ambulance staff is essential for reducing unscheduled hospital care.

Aim: To reduce unscheduled hospital care for adults with diabetes-related hypoglycaemia who require assistance from the ambulance services.
Methods: A four-stage study that was cross-jurisdictional and utilised multi-methods was carried out. A systematic literature review was conducted in Stage 1 of this study. Retrospective ambulance datasets were analysed using the programmes R and SPSS in Stage 2. Documents relating to the treatment and management of hypoglycaemia were analysed using discourse analysis in Stage 3. Semi-structured interviews that were analysed using Braun and Clarke’s (2012) thematic analysis were carried out in Stage 4. A pragmatic approach was utilised with a clinical decision-making framework used to guide Stage 4 and the discussion chapter.

Results: Unscheduled hospital care can be reduced through effective community-based interventions. Males over 55 and those from more deprived areas were most likely to contact ambulance services, although older females were more likely to be conveyed. Calls outside GP working hours were less likely to result in patients being taken to hospital. Significant differences exist in the prehospital care pathways utilised in each jurisdiction. Ambulance staff rely on toolkits of care to aid their confidence when leaving patients at home. Support for both ambulance staff and patients is essential to ensure safe and person-centred care.

Conclusion: This project has highlighted the integral role of the ambulance services in providing care to adults with hypoglycaemia, related to their diabetes, and has shown that developing these services further can reduce unscheduled hospital care and lessen the burden on emergency departments. It has provided an evidence base to support the implementation of ‘treat and leave’ in Ireland. Furthermore, it has also shaped the groundwork for revisions to the clinical care pathway for ambulance service management of hypoglycaemia in Northern Ireland and Scotland.

Date of Award	Jun 2022
Original language	English
Sponsors	INTERREG IVA administered by the SEUPB.
Supervisor	Vivien Coates (Supervisor) & Donna Mc Connell (Supervisor)