Reducing Diabetes Mellitus (DM) Related Admissions in Emergency Department (ED)
Care Continuum
National University Health System Quality Improvement
National University Health System
31 December 2023
To reduce DM-related admissions in NTFGH ED attendances from 67.5% to 53% by September 2023. Reducing admissions through care redesign and targeted interventions improved resource utilization while enhancing DM patient outcomes.
Year Submitted: 2023
Published Date: 31 December 2023
Tags: Care Continuum, Intermediate and Long Term Care ＆ Community Care, Right-Siting, Chronic Care, Primary Care, Self Care
About this Content
Aims
To reduce DM-related admissions in NTFGH ED attendances from 67.5% to 53% by September 2023.
Background
67% of DM-related ED attendances resulted in admissions, but ~20% were avoidable (short 1-2 day stays). Interventions aimed to streamline care pathways and improve DM management.
Methods
Revised Hyperglycemia and Hypoglycemia protocols with EDTU.
Integrated referral processes to H2H services.
Adopted Best Practice Advisory (BPA) in Epic to prompt referrals for high-risk DM patients.
Tested changes using PDSA cycles and analyzed results.
Results
Hyperglycemia Protocol: 77% of patients successfully discharged.
Hypoglycemia Protocol: 69% of patients successfully discharged.
H2H referrals improved with BPA criteria (HbA1c >9%, medication non-compliance, psycho-social issues).
Conclusion
Reducing admissions through care redesign and targeted interventions improved resource utilization while enhancing DM patient outcomes.
Lessons Learnt
Flexibility in implementation processes (e.g., system workarounds) accelerated testing. Human factors and technology alignment ensured success.
Additional Information
Project integrated into Epic with ongoing BPA refinements.
Keywords
Diabetes Management, Hyperglycemia, Hypoglycemia, Admission Reduction, H2H Services, Best Practice Advisory, Care Continuum, NTFGH
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National University Health System |
Organization(s) Involved | Ng Teng Fong General Hospital |
Platform(s) | National University Health System Quality Improvement |
Healthcare Professional Group(s) | Nursing, Medical |
Applicable Specialty or Discipline | Endocrinology |
Project Lead(s) | Esther Tan |
Project Member(s) | Norhafizah Tajut Rin |
Connect with this contributor!
Ng Kai Xin - kx_ng@nuhs.edu.sg
Project Attachment
382_NTFGH_QM_2023_Reducing_Diabetes_Mellitus_DM_Related_Admissions_in_Emergency_Department_ED.pdf