Diabetes program focuses on the basics
Patients learn skills to keep them safe
Executive Summary
Vidant Medical Center in Greenville, NC, is saving about $425,000 a year by implementing a multidisciplinary model that teaches patients with diabetes the basic skills they need to stay safe after discharge.
• A multidisciplinary team that included pharmacy, nutrition, nursing, and case management developed the program after data showed that the hospital’s traditional diabetes program was reaching only about 20% of the diabetes population.
• The team determined that patients need four survival skills to stay healthy at home: medications, glucose monitoring, hypoglycemia recognition, and having a relationship with a primary care provider in the community.
• The team developed a graphic that illustrates what the medical provider, the bedside nurse, the pharmacist, the case manager or social worker, and the nutritionist need to do for all patients with diabetes. Each member of the team also reinforces the four survival skills.
Recognizing that it’s difficult to teach patients everything they need to know about managing their diabetes during today’s short hospital stays, Vidant Health has developed and implemented a multidisciplinary model that concentrates on the basics and focuses on making sure patients are safe after discharge.
“There’s not a lot of time during a hospital stay for comprehensive diabetes training. We determined that patients need four survival skills: medications, glucose monitoring, hypoglycemia recognition, and having a relationship with a primary care provider in the community,” says Sandra Hardee, PharmD, CDE, diabetes program manager at Vidant Medical Center in Greenville, NC.
The change to the new model saved the institution approximately $425,000 a year, which translates to an average per-patient savings of almost $35 a year, Hardee says.
The hospital used University Health Consortium data to track length of stay and admission rates for diabetes patients and compared data for nine months before the new model was implemented and nine months after implementation.
“There was no significant difference in the median length-of-stay or the 30-day all-cause readmission rates when diabetes was the primary or secondary diagnosis. However, these data indicate that the model is working at least as well as the previous model, at a substantial annual cost savings,” Hardee adds.
The hospital’s established diabetes program employed five nurse educators but the program did not seem to be affecting outcomes, Hardee says. “The program ran by referral and we were touching only about 20% of the diabetes population,” Hardee says.
The health system’s executive leadership agreed to let the diabetes team develop another model that would reach more patients, provide a consistent message, and lead them to outpatient diabetes resources for ongoing care.
An interdisciplinary team that included pharmacy, nutrition, nursing, and case management collaborated to develop an inpatient diabetes program that uses the resources and expertise on hand to reach all the patients and improve outcomes, Hardee says.
“We knew we had to think outside the box. We conducted a review of the literature and brainstormed about the most important things that the patient really needed to know,” says Amanda Hargrove, RN, MSN, ACM, administrator for case management service at Vidant Medical Centers.
The team decided that its focus should be on providing information and teaching skills that will keep patients safe, rather than trying to teach them everything about diabetes in a short period of time, she says.
The team then developed a graphic that illustrates what the medical provider, the bedside nurse, the pharmacist, the case manager or social worker, and the nutritionist need to do for all patients with diabetes.
For instance, the bedside nurse assesses patients for educational needs with the goal of making sure the patient understands the four survival skills. The case manager assesses the patient for discharge needs with the goal of connecting the patient to needed post-acute resources. The case manager also makes sure the patient has diabetes supplies, and provides the patient with information on outpatient diabetes educational resources.
“This model helps us become patient-centered and guarantees that we give patients what they need. It’s a multidisciplinary effort between the pharmacist, the bedside nurse, and the case manager, with the case manager ensuring that it’s all tied together at discharge,” Hargrove says.
Every patient with diabetes is automatically enrolled in the program upon admission. “When patients come into the hospital, the nurse determines if they have diabetes as a primary or a secondary diagnosis,” Hardee says. For instance, patients hospitalized with pneumonia who also have diabetes receive the inpatient diabetes interventions.
The diabetes model has three different tracks: one for newly diagnosed diabetics, one for patients who were previously diagnosed with diabetes, and one for patients who are new to insulin, Hargrove says.
“This helps us tailor the interventions to the patient’s needs. For instance, someone who is a newly diagnosed diabetic needs a nutrition consultation,” she adds.
The case managers start the discharge planning process as soon as the nurse identifies which track the patient should be on. They make sure that the patient has a primary care physician and has a follow-up appointment.
“Our providers know that the patient has diabetes and they take this into consideration when developing a discharge plan based on medication and resources the patient needs,” Hardee says.
The core team calls on pharmacists and nutritionists to see the patients as needed. “We always call on nutritionists for new diabetics. We bring in a pharmacist for the more complex patients, those who need to transition to a different regimen, and those with complex educational needs. All of the team members reinforce the four survival skills,” Hardee says.
The inpatient team also collaborates with community partners to ensure that the patients get what they need after discharge, Hargrove says.
The case management department maintains a resource index that the case manager can use to print out all the community diabetes resources near the patient’s home. Patients who are at low or moderate risk may be referred to a community-based educational class, or to the diabetes education section on the hospital’s intranet.
“We connect patients with the resources in the community while they are in the hospital. It may be home health or telehealth or a care coordinator who follows them in the community,” she adds.
The hospital team automatically refers at-risk patients to the Vidant Health care coordination team, which provides home visits and services based on each individual patient’s needs.
If patients are covered by Community Care Plan of Eastern Carolina, they transition to a case manager from that organization, she adds. Community Care Plan of Eastern Carolina is a regional network within Community Care Plan of North Carolina, the entity that manages much of North Carolina’s Medicare funds.
“It a matter of creating a smooth transition and connecting patients with community resources depending on their needs,” Hargrove says.
Vidant Medical Center in Greenville, NC, is saving about $425,000 a year by implementing a multidisciplinary model that teaches patients with diabetes the basic skills they need to stay safe after discharge.
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