Original researchNon elective re-admissions to an acute hospital in people with diabetes: Causes and the potential for avoidance. The WICKED project

- NEAs in people with diabetes are mainly due to multi morbidity and only few are related to diabetes.
- Most NEAs are justified at the time of admission and potential of avoidability is with early intervention.
- Most diabetes related NEAs are avoidable.
- We may be able to use an index admission to predict future NEA.
- Our ways of working and training programme in diabetes and endocrinology require changes to allow integrated patient care.

IntroductionManaging people with diabetes is a health priority worldwide. Cost benefit attempts at avoiding non elective admissions (NEA) have had some success. To develop an NEA avoidance service, we audited multiple NEA in those with diabetes.MethodAll people with diabetes who had ≥3 NEA to our hospital over 12 months were identified (n = 418); 104 (1 in 4) patients were randomly selected and retrospective data collected in 98 subjects on their index (latest, 3rd) admission.ResultsOf 98 subjects (50 males, 60 Caucasians, 86 type 2 diabetes, aged 69 ± 16 years).Conditions contributing to admission included: Significant co-morbidities in 95 patients (≥2 in 57, ≥4 in 24). Only 14 admission were directly due to diabetes: hypoglycaemia (5); hyperglycaemia (6); DKA (2), Infected foot ulcer (1).97 admissions were justified at the time of presentation. However whilst 78 were unavoidable, 19 were deemed avoidable amongst whom 10 were diabetes related.ConclusionThe majority of re-admissions were due to multi-morbidity and were often non-diabetes related. The concept of avoidability must be distinguished from point justification at the time of acute need. This would allow the prospective identification of high risk patients and requires an integrated working process to avoid NEA.