Endocrine Abstracts

Background/Introduction: The Best Practice Tariff was introduced in 2012 in England and Wales to provide adequate funding and ensure quality care for all children with Diabetes. The tariff criteria states that units must provide “24 hour access to advice and support” including “24 hour expert advice to other healthcare professionals”. The aims of this audit were to: evaluate the Nottingham Children’s Hospital out of hours paediatric diabetes service, determine its effectiveness and its compliance with the Best Practice Tariff standards.

Methods: All out of hours calls between December 2015 and June 2016 were logged and further details were entered into a spreadsheet. Details included: reason for the call, whether local guidelines were followed, if the diabetes consultant was contacted, whether the patient was admitted and subsequent follow up. Data was then analysed to see what proportion of responses to out of hours calls met the criteria and whether the system used is effective.

Results: 35 calls were logged, with an additional 22 being initiated by diabetes consultants to families of newly diagnosed patients or those recently started on pump therapy. Of the 35 calls, 26 were family members requesting advice from the paediatric medical registrar on call. All the advice given followed local guidelines and a diabetes consultant was contacted for advice in 60% of cases. 9 calls were from health professionals and went directly to the paediatric diabetes consultant on call. The main issues requiring advice were hypoglycaemia (6), hyperglycaemia (9), inter-current illness (10), insulin pump problems (7), perioperative advice (1), diabetic ketoacidosis (3) and missed doses of insulin (1). 5 patients (14%) required admission: 2 for hyperglycaemia, 2 for hypoglycaemia, 1 unrelated to diabetes. 6/35 patients were under a different diabetes team, with no follow up information. Of the remaining 29, 22 (75%) received a phone call from the diabetes specialist nurse on the next working day.

Conclusion: The out of hours service provided by Nottingham Children’s Hospital is an effective system which allows families (and health professionals) to receive appropriate advice at home (hospital) and helps to prevent unnecessary admissions. It fulfils the criteria outlined by the Best Practice Tariff.