Background and Aim
Patients with diabetes can experience repeat presentations to hospital.We sought a screening tool to identify diabetes patients at risk of unplanned re-presentation, to facilitate early referral to services to support them to stay well at home. A literature search failed to identify an appropriate tool but a literature and a medical record audit of re-presenting diabetes patients identified variables commonly linked to re-presentation: comorbidities, polypharmacy, needing a carer and mental ill health/substance use/cognitive impairment.
Method
We assembled a draft screening tool using potential predictive variables. comprising a short questionnaire and three tests of aspects of cognitive function impacting self-care capacity; The Clock Drawing Test (CDT), Colour trails Test (CTT) and Frontier Executive Working Memory Test (FEWMT).
We pilot-tested the tool and examined its feasibility for use by medical/nursing staff and acceptability to patients.
Preliminary Findings
We recruited a convenience sample of 45 diabetes patients (27 male);averaging 69 years in the Emergency Department and Wards of a tertiary hospital. Overall, 60% had >5 comorbidities; 75% took >8 medications; 38% lived alone; 51% need help with daily activities; 53% had a formal or informal carer; 27% had a history of mental illness,substance abuse,dementia or developmental delay.
One patient was blind and one was unable to complete the CDT or FEWMT; 5 were unable to complete the CCT. The whole tool averaged 19 minutes to complete, with CTT the longest component. Altogether 58% failed the CDT; 91%, 82% and 31% correctly recalled 2, 3 or 4-letter sequences of the FEWMT; 35.5% returned to hospital within 28 days.
Conclusion
We eliminated the CTT and refined questionnaire wording. The revised tool will be piloted with a larger sample to test its ability to discriminate patients likely to re-present within 28 or 90 days.
We acknowledge the funding support of the POWH Foundation.