Auditing paediatric diabetes care and the impact of a specialist nurse trained in paediatric diabetes

Accepted 13May 1997
AIMS—To define outcome measures for auditing theclinical care of children and adolescents with insulin dependentdiabetes mellitus (IDDM) and to assess the benefit of appointing adedicated paediatric trained diabetes specialist nurse (PDSN).
METHODS—Retrospective analysis of medical notesand hospital records. Glycaemic control, growth, weight gain,microvascular complications, school absence, and the proportion ofchildren undergoing an annual clinical review and diabetes educationsession were assessed. The effect of the appointment of a PDSN on thefrequency of hospital admission, length of inpatient stay, andoutpatient attendance was evaluated.
RESULTS—Children with IDDM were of normal heightand grew well for three years after diagnosis, but grew suboptimallythereafter. Weight gain was above average every year after diagnosis.Glycaemic control was poor at all ages with only 16% of childrenhaving an acceptable glycated haemoglobin. Eighty five per cent ofpatients underwent a formal annual clinical review, of whom 16% hadbackground retinopathy and 20% microalbuminuria in one or moresamples. After appointing the PDSN the median length of hospital stayfor newly diagnosed patients decreased from five days to one day, with10of 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 medianof 19 to 10%.
CONCLUSIONS—Outcome measures for evaluating thecare of children with IDDM can be defined and evaluated. Specialistnursing support markedly reduces the length of hospital stay of newlydiagnosed patients without sacrificing the quality of care.