Changing inpatient diabetes care in a district general hospital

Marie Wallner, Basharat Andrabi, David Russell-Jones, Roselle Herring


Introduction: People with diabetes in hospital have longer lengths of stay and are at higher risk of experiencing avoidable harm. This has a significant impact on patient flow and capacity in any hospital Trust.

Aims and Methods: A Trust-wide peripatetic inpatient diabetes service redesign was performed to deliver reduced medication errors, improved patient flow, reduced length of stay and reduced inpatient risk. The service redesign was delivered without new recurring expenditure on senior staff. The model of care was multidisciplinary and introduced consensus and evidence-based care with clear governance processes.

Results: Following introduction of the new service on 7 December 2017 to 1 June 2018, a reduction in length of stay in both medicine and surgical divisions was seen with 2,168 ‘saved’ inpatient bed days compared with the same time period in the preceding year, which represented a significant cost saving for the Trust and improvement in patient flow. This was associated with a reduction in the number of diabetes-related Datix reports and serious untoward incidents.

Conclusions: This is the first major diabetes service redesign in a small district general hospital. The introduction of a dedicated inpatient diabetes service has led to Trust-wide improvements in patient care and patient flow without additional cost to the Trust.


diabetes, inpatient, length of stay, strategy, district general hospital, patient harm

Full Text:



Kerr M. Inpatient care for people with diabetes: the economic case for change.

Health and Social Care Information Centre. National Diabetes Inpatient Audit (NaDIA) – 2017. 2017

Joint British Diabetes Societies for Inpatient Care (JBDS-IP). The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus, 3rd edition. Revised February 2018. (accessed March 2019)

National Diabetes Information Service. Diabetes Inpatient Mortality Profile Report 2010–2012.

Diabetes UK. Admissions avoidance and diabetes: guidance for clinical commissioning groups and clinical teams. Joint British Diabetes Societies for Inpatient Care (JBDS-IP). December 2013 (accessed March 2019).

Diabetes UK. Making hospitals safe for people with diabetes. 2018.

NHS Digital. National Diabetes In-patient Audit – Harms. (accessed March 2019).

Bansal V, Mottalib A, Pawar TK, et al. Inpatient diabetes management by specialized diabetes team versus primary service team in non-critical care units: impact on 30-day readmission rate and hospital cost. BMJ Open Diabetes Res Care 2018;6(1):e000460. 10.1136/bmjdrc-2017-000460

Flanagan D, Moore E, Baker S, Wright D, Lynch P. Diabetes care in hospital--the impact of a dedicated inpatient care team. Diabet Med 2008;25(2):147–51. 10.1111/j.1464-5491.2007.02326.x



  • There are currently no refbacks.

The Journal of the Association of British Clinical Diabetologists