A team led by a consultant anaesthetist based in Newport has been named the winner of the prestigious Rowan Hillson Inpatient Safety Award 2019.
The team, led by Dr David Burckett-St.Laurent, from the Aneurin Bevan University Health Board, scooped the prize for a cross specialty working group who re-designed the perioperative care pathway for surgical patients with diabetes. Their work led to significant improvements for staff and people with diabetes.
Dr Nicola Leech, Consultant in Diabetes and Metabolic Medicine and her team at the Newcastle upon Tyne Hospitals NHS Foundation Trust was the runner-up.
It was inspiring to see so many impressive entries, summarising a huge amount of work to improve patient care Dr Rowan Hillson MBE
Their work led to reducing pre-operative overnight admissions for poorly controlled diabetes patients, whilst improving glycaemic control for all patients on day of surgery. In addition, insulin errors and hypoglycaemia on surgical wards has been reduced by > 50%. Surgical wards are now the safest place for people with diabetes in the Trust.
But the winning team’s approach involved standardising all pre-operative assessments of all people and, where appropriate, peri-operative diabetic control was optimised.
Each person was provided with a personalised diabetes management plan which contained information on usual drug treatment, ‘pre-op/ day of surgery’ diabetes medicine modification, as well as advice on hypoglycaemia management and sick day rules.
The innovation meant the existing practice was completely overhauled, which required widespread cultural and organisational change.
Everyone whose HbA1c levels were >69 mmol/mol underwent an anaesthetic review and those suitable for pre-operative optimisation of diabetic control (generally elective patients, non-USC) were fast tracked for secondary care diabetes review.
Eventually the team saw major improvements in the peri-operative management of diabetes. This included optimised diabetes control, enhancements in patient education and safety, clearer information about medicine management in the fasting period to patients and staff, and demonstrated better clinical outcomes.
Now, 100% of patients are provided with a generated plan. In April 2018/19 there were 1,000 standardised pre-assessment plans completed by 60 different clinicians.
Dr Rowan Hillson MBE said: “It was inspiring to see so many impressive entries, summarising a huge amount of work to improve patient care. Perioperative care brings together many different specialties and systems and it is really good to see the excellent collaboration and shared learning demonstrated in these projects. There are lessons to learn in all the entries.
“Many congratulations to David Burckett-St.Laurent and the extensive multi-specialty team at the Aneurin Bevin University Health Board for their excellent description and careful analysis of a project which completely restructured existing care for people with diabetes undergoing surgery.”
JBDS Chair Professor Ketan Dhatariya, who was also on the judging panel, added: “There were so many fantastic entries, and the judges had a hard time deciding who should win.
“I am very grateful to all of those who spent time and effort putting together their submissions. So many of them had great ideas and innovations. More importantly we continue to thank all of those teams who go the extra mile to help improve the care of people with diabetes in hospital undergoing surgery– whether they submitted an entry or not.
“We are in the process of deciding the subject for the next award – it probably will be COVID related, so watch this space!”
The annual award is organised by the Joint British Diabetes Societies for Inpatient Care (JBDS – IP), with the project being led by Dr Umesh Dashora, Debbie Stanisstreet and Erwin Castro.
Dr Dashora said: “The Diabetes Inpatient Safety Group has been organising the Rowan Hillson Inpatient Safety Award every year and we were pleasantly surprised and highly inspired by all the innovations all around the country which have improved patient care in general. I hope all the Trusts in the UK will look at these innovations and adapt them for local use if appropriate.”
The submissions were judged against predetermined criteria, by an independent panel chaired by Dr Hillson MBE.