Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Clinician follow-up of elevated glycated haemoglobin results in hospital inpatients (#255)

Tim Lin 1 , Paul Chubb 2 3 , Seng Khee Gan 1 4 , Samuel D Vasikaran 2 , Gerard T Chew 1 4
  1. Endocrinology and Diabetes, Royal Perth Hospital, Perth, Western Australia, Australia
  2. Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth and Fiona Stanley Hospitals, Perth, Western Australia, Australia
  3. School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
  4. School of Medicine, University of Western Australia, Perth, Western Australia, Australia

Background: Diabetes is prevalent amongst hospital inpatients, and hyperglycaemia is associated with poorer outcomes. An elevated glycated haemoglobin (GHb) level indicates chronic hyperglycaemia and should prompt action to improve glycaemic control.

Objective: To audit clinician follow-up of elevated GHb results in hospital inpatients.

Method: We extracted from the PathWest electronic database the results of all inpatient GHb measurements performed over a three-month period at Royal Perth Hospital (RPH), a teaching tertiary hospital in metropolitan Perth, Western Australia. For the inpatients with GHb ≥9%, we examined their discharge summary and electronic referral records to determine if they were referred for specialist diabetes review (inpatient or outpatient) and/or had their diabetes treatment altered.

Results: In the three-month audit period, there were 764 GHb measurements performed on RPH inpatients, 134 (18%) of which yielded a result ≥9%. Of these, six were repeat GHb measurements performed during the same inpatient admission, and another two were performed on the same patient on separate admissions during the audit period. Of the 128 admissions that had a GHb result ≥9%, 20 (16%) were under Endocrinology specialist care. Of the remaining 108 admissions under medical (87, 81%) and surgical (21, 19%) subspecialty care, 55 (51%) were referred for inpatient Endocrinology review, and another seven (6%) were referred for outpatient Endocrinology follow-up. Of the remaining 46 admissions not referred to Endocrinology, 13 (28%) had their diabetes medications changed by their treating team. Overall, 26% of inpatients with GHb ≥9% were not referred for Endocrinology specialist review or follow-up, nor had their diabetes medication altered.

Conclusion: There may be opportunities to improve the glycaemic control of hospital inpatients by improving clinician follow-up of elevated GHb results, and facilitating referral pathways and access to specialist review. There is also potential to save costs by avoiding unnecessary repetition of blood tests.