Unplanned representation to hospital by patients with diabetes: development and pilot feasibility testing of a screening tool

Abstract

Background: Unplanned representation of patients with diabetes recently discharged from the emergency department or in-patient hospital settings is a common but complex problem world-wide. This study set out to examine the feasibility of a risk screening interview and whether component characteristics may be associated with the unplanned representation of patients with diabetes to a tertiary metropolitan hospital.

Methods: A screening interview comprised of demographic, social and clinical characteristics was developed and piloted using a prospective cross-sectional survey design. A convenience sample of 55 patients was recruited and screened. Outcomes were the occurrence of unplanned representation to hospital within 28 or 90 days of hospital discharge from the index presentation.

Results: The screening interview was shown to be broadly feasible and acceptable for use by staff and patients, with identified areas for modification. Seventeen participants (30.9%) experienced unplanned representation within 90 days of hospital discharge; for 13 participants (23.6%) this occurred within 28 days. Characteristics linked with unplanned representation to hospital were identified.

Conclusions: Preliminary data indicated the feasibility of tool use and informed refinement for future testing of the ability of the screening interview to predict those patients with diabetes at high risk of unplanned representation to hospital, to enhance effective care planning.

Impact statement: Patients with diabetes commonly present to Emergency Departments, and demonstration of the feasibility of a screening interview to determine those at elevated risk of unplanned representation is an important step towards effective management. Data supported refinement and future testing of the new screening interview.

Keywords:

• diabetes mellitus
• emergency department
• hospital
• cognitive
• feasibility
• nurses
• representation
• screening

Acknowledgements

Drs Kristina Barisic and Vince Oxenham (Clinical Neuropsychiatrists), and Sarah Lyons (Clinical Nurse Consultant), for their input to components of protocol development (KB, VO and SL) and data collection (KB). Thanks to the patients and staff who supported the conduct of this study. The study was conceived as an initiative of South East Sydney Local Health District. LP, JG and WV conceived and designed the study proposal, and secured funding. JG supervised data collection. LP and SJ analysed the data. All authors prepared and approved the manuscript. The study was approved by South Eastern Sydney Local Health District Human Research Ethics Committee (approval number: 16/211 (LNR 16/POWH/421)).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Geolocation

This study was undertaken in Randwick, New South Wales 2031, Australia.

Additional information

Funding

This work was supported by a grant from the Prince of Wales Hospital Foundation, New South Wales, Australia.