Endocrine Abstracts

Peer Review programmes (PRP) help organisations to improve the quality of clinical services in a developmental and supportive way. The West Midlands Paediatric diabetes network (WMPDN) consists of 15 National Health Service (NHS) Trusts looking after 2800 children (aged 0–18 years). 2010/2011 National Paediatric diabetes audit (NPDA) data showed that the median HBA1c achieved in the region was 69 mmol/mol. In order to improve the metabolic control and quality of care, the network embarked on a PRP.

Method: Following development of network quality standards and formal training of members of the diabetes multidisciplinary team, parents and commissioners as reviewers, all the NHS Trusts carried out a self assessment of compliance against the quality standards. This was followed by review visits (September 2012–march 2013) assessing all aspects of the patient journey. During the visit of facilities, patients, parents, medical, nursing, dietetic are interviewed. Results of visits are sent to Trust chief executives and will be made public.

Results: 14/15 Trusts have had visits. 48 reviewers trained. The median level of compliance following visits was significantly lower than self-assessment of compliance (61 vs 81%) (P<0.001). The level of compliance amongst the Trusts varied from 38 to 86%, There was a significant positive correlation between level of compliance following peer review (CPR) and percentage of children in the unit with HBA1C <58 mmol/l (r=0.63, P=0.028). 64% did not have adequate specialist nursing /dietetic staff for the number of children in their caseload. 65% did not offer regular robust structured group patient education on an ongoing basis.57% did not have robust arrangements for ensuring all children received all care processes as defined by NPDA. Transition arrangements were judged inadequate in 50%.

Conclusion: PRP has enabled the network to identify areas of service that need improvement. 88% of reviewers report using the experience to improve their services.