PMID- 30022426 OWN - NLM STAT- MEDLINE DCOM- 20191021 LR - 20221207 IS - 1708-0428 (Electronic) IS - 0960-8923 (Linking) VI - 28 IP - 10 DP - 2018 Oct TI - Effective Implementation of Peri-operative Local Guidelines for Metabolic Surgery in Patients with Diabetes Mellitus in a Tier 4 Setting Demonstrate Improved Work Efficiency and Resource Allocation. PG - 3342-3347 LID - 10.1007/s11695-018-3389-3 [doi] AB - BACKGROUND: Dynamic changes in glycaemia predominate peri-operatively in patients with type 2 diabetes mellitus (T2DM) undergoing metabolic surgery. There is a lack of consensus and clear guidance on effective glycaemic management of such patients. The aim of this study was to design, pilot, and implement a proforma to improve consistency of glycaemic management and clarity of communication with healthcare professionals following metabolic surgery in patients with T2DM, thereby reducing unnecessary diabetes specialist nurse (DSN) referrals. METHODS: A proforma was designed and piloted for 12 months to guide healthcare professionals on managing glycaemic therapies for T2DM patients undergoing metabolic surgery. Glycaemic control (HbA1c) and glycaemic therapies were reviewed 3 weeks pre-operatively and a proforma was completed accordingly. RESULTS: Of the patients with T2DM (n = 34) who underwent metabolic surgery prior to the new proforma being implemented, 71% (n = 24) had a DSN referral. Half of these referrals were deemed unnecessary by the DSNs. Of the patients with T2DM (n = 33) who underwent metabolic surgery following implementation of the proforma, 21% (n = 7) had a DSN referral. Only 10% of these were deemed unnecessary. Despite the reduced DSN input, no diabetes-related complications were reported. CONCLUSION: Implementation of our proforma effectively halved the proportion of patients with T2DM requiring a DSN referral. Additionally, there was a 40% absolute reduction in the proportion of unnecessary DSN referrals. The proforma improved clarity of communication and guidance for healthcare professionals in the glycaemic management of patients. This also facilitated improved work efficiency and resource allocation. FAU - Shah, Neha AU - Shah N AUID- ORCID: 0000-0002-8105-3969 AD - Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK. Neha.shah@uhcw.nhs.uk. AD - Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK. Neha.shah@uhcw.nhs.uk. FAU - Abraham, Jenny AU - Abraham J AD - Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK. AD - Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK. FAU - Goodwin, Wendy AU - Goodwin W AD - Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK. AD - Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK. FAU - Kahal, Hassan AU - Kahal H AD - Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK. AD - Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK. FAU - Menon, Vinod AU - Menon V AD - Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK. AD - Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK. FAU - Lam, F T AU - Lam FT AD - Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK. AD - Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK. FAU - Barber, Thomas M AU - Barber TM AD - Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK. AD - Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK. LA - eng PT - Journal Article PL - United States TA - Obes Surg JT - Obesity surgery JID - 9106714 RN - 0 (Blood Glucose) RN - 0 (Glycated Hemoglobin A) SB - IM MH - Adult MH - Bariatric Surgery/economics/methods/*standards MH - Blood Glucose/metabolism MH - Diabetes Mellitus, Type 2/economics/epidemiology/*surgery MH - Female MH - Glycated Hemoglobin/metabolism MH - *Guideline Adherence/economics/organization & administration/standards MH - *Health Plan Implementation/economics/organization & administration/standards MH - Humans MH - Male MH - Middle Aged MH - Obesity, Morbid/economics/epidemiology/surgery MH - Perioperative Care/methods/*standards MH - Pilot Projects MH - Program Evaluation MH - *Resource Allocation/economics/organization & administration/standards/statistics & numerical data MH - Tertiary Care Centers/economics/organization & administration/standards MH - United Kingdom/epidemiology MH - *Work Performance/organization & administration/standards/statistics & numerical data OTO - NOTNLM OT - Glycaemic control, sleeve gastrectomy OT - Metabolic surgery OT - Type 2 diabetes mellitus EDAT- 2018/07/20 06:00 MHDA- 2019/10/23 06:00 CRDT- 2018/07/20 06:00 PHST- 2018/07/20 06:00 [pubmed] PHST- 2019/10/23 06:00 [medline] PHST- 2018/07/20 06:00 [entrez] AID - 10.1007/s11695-018-3389-3 [pii] AID - 10.1007/s11695-018-3389-3 [doi] PST - ppublish SO - Obes Surg. 2018 Oct;28(10):3342-3347. doi: 10.1007/s11695-018-3389-3.