Auditing paediatric diabetes care and the impact of a specialist nurse trained in paediatric diabetes
a Department of Child Health, University Hospital of
Wales, Cardiff, b University of Wales, College of Medicine, Cardiff
Correspondence to: Dr Fiona J Cowan, Department of Child Health, University Hospital of Wales, Heath Park, Cardiff CF4 4XW.
Accepted 13
May 1997
AIMS
To define outcome measures for auditing the
clinical care of children and adolescents with insulin dependent
diabetes mellitus (IDDM) and to assess the benefit of appointing a
dedicated paediatric trained diabetes specialist nurse (PDSN).
METHODSRetrospective analysis of medical notes
and hospital records. Glycaemic control, growth, weight gain,
microvascular complications, school absence, and the proportion of
children undergoing an annual clinical review and diabetes education
session were assessed. The effect of the appointment of a PDSN on the
frequency of hospital admission, length of inpatient stay, and
outpatient attendance was evaluated.
RESULTSChildren with IDDM were of normal height
and grew well for three years after diagnosis, but grew suboptimally
thereafter. Weight gain was above average every year after diagnosis.
Glycaemic control was poor at all ages with only 16% of children
having an acceptable glycated haemoglobin. Eighty five per cent of
patients underwent a formal annual clinical review, of whom 16% had
background retinopathy and 20% microalbuminuria in one or more
samples. After appointing the PDSN the median length of hospital stay
for newly diagnosed patients decreased from five days to one day, with
10 of 24 children not admitted. None of the latter was admitted during the next year. There was no evidence of the PDSN affecting the frequency of readmission or length of stay of children with established IDDM. Non-attendance at the outpatient clinic was reduced from a median
of 19 to 10%.
CONCLUSIONSOutcome measures for evaluating the
care of children with IDDM can be defined and evaluated. Specialist
nursing support markedly reduces the length of hospital stay of newly
diagnosed patients without sacrificing the quality of care.
© 1997 by Archives of Disease in Childhood
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