An Audit of Hypoglycaemic Presentations to the Emergency Department — ASN Events
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An Audit of Hypoglycaemic Presentations to the Emergency Department (#118)

Kathleen M Steele 1 , Lisa Iulianetti 1 , Richard MacIsaac 1 , Margaret Loh 1 , Elizabeth O'Meara 1 , Glenn Ward 1
  1. Endocrinology & Diabetes, St Vincent's Hospital, Fitzroy, Melbourne, VIC, Australia

Introduction
Severe hypoglycaemia (hypo) can be a life threatening event and major cost burden to healthcare systems (1). A retrospective audit of our Emergency Department (ED) identified 56 cases of patients with diabetes admitted with hypoglycaemia. A deficit was identified in the patients’ discharge information and follow-up. A literature search confirmed inadequate patient discharge information following admission to ED’s with hypoglycaemia (2, 3, 4).

Aims:
1. Audit hypoglycaemia attendances in ED over a 6 month retrospective period
2. Identify deficit in discharge advice given to patients
3. Audit multidisciplinary follow-up appointments

Methodology
The project commenced February 2012. Retrospective data were collected over a 6 month period between June and December 2011. 56 patients aged 18-88years old were coded with diabetes and hypoglycaemia. Of these, 45 patients were audited. The remaining 11 had no notes available.

Results
42% of audited patients had Type 1 diabetes (4% on insulin pumps), 47% had Type 2 diabetes, and 11% not documented. 68% used insulin only, 13% used both insulin and a sulphonylurea, and 11% used a sulphonylurea only. 31% had a documented loss of consciousness (LOC), 17% had a documented mental health issue, 82%were admitted before 10pm, and 4% patients had suffered the hypo whilst driving.
27% of patients required admission.

Discharge documentation:
No standardized advice given to patients.
No advice documented- 18%
Appropriate advice given, medication adjustment occurred -18%

Follow-up documentation:
Patients referred to GP- 29%
Patients referred to Diabetes Education- 18%
Patients referred to Dietitian- 2%
Endocrinologist referral- 2%
Patients left before being seen-9%

Conclusion
A deficit in discharge advice and follow up given to patients presenting to ED with hypoglycaemia was identified.
Discharge information with standardized advice and referral guidelines has been developed and is being piloted.
A follow-up audit will occur 6 months post pilot

A NovoNordisk regional diabetes support grant scheme funded this project.

  1. The economic costs of hypoglycaemia” BRIAN M FRIER, British Journal of Diabetes & Vascular Disease, 2011 11: 10
  2. Anthony M, “Treatment of Hypoglycaemia in Hospitalised Adults: A Descriptive Study.” The Diabetes Educator 2007, 33: 709-715
  3. “Hospitalization and Discharge Education of Emergency Department Patients With Hypoglycemia”, Adit A. Ginde, Daniel J. Pallin and Carlos A. Camargo, Jr. The Diabetes Educator 2008 34: 683
  4. Funnell M, “The Diabetes Attitudes, Wishes, and Needs (DAWN) Study – A review” Clinical Diabetes 2006; 24:154-155
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