National Diabetes Inpatient Safety Audit (NDISA) 2018-2021

The National Diabetes Inpatient Safety Audit (NDISA) undertakes a continuous collection of 4 life-threatening diabetes-specific inpatient harms that occur due to errors of inpatient diabetes management. These events are distressing, slow-down recovery, may be life-threatening and should be preventable. The collection started on 1 May 2018 and was previously known as the National Diabetes Inpatient Audit (NaDIA) – Harms.

It is a mandatory requirement for acute hospitals in England to participate in the NDISA harms collection. 126 NHS Trusts in England are known to be eligible¹ for the NDISA harms collection; 113 are registered; 109 participated²; and 63 are regularly submitting³ to the NDISA harms collection.

Based on the numbers of NHS trusts known to be eligible , participation in the NDISA harms collection is presently 87% (109 of 126), with 58% (63 of 109) participating regularly . There have been 6 new participants in the preceding year (November 2020 to October 2021).

In the upcoming year (2022), the NDISA team will start contacting non-participating NHS trusts to ask them why they have not taken part, and to suggest that they offer support to diabetes teams to enable them to submit data.

Notes:

1. Eligibility inferred from NaDIA snapshot participation (2015-19) and/or NDISA harms audit participation (see note 2).

2. 1 or more inpatient harm submission or any verified monthly nil submission.

3. As for note 2, in all 8 quarters of latest 2 years: November 2019 to October 2021.

Table 4.1: Number of inpatient harms, by harm type and quarter when inpatient harm occurred, England, May 2018 - October 2021 (rounded¹)

Notes:

1. Counts have been rounded. Counts between 1 and 7 are represented as a 5. All counts greater than 7 have been rounded to the nearest 5. Consequently the total will not usually match the sum of the 4 constituent inpatient harms.

Chart 4.2 (below) shows that the rate of total inpatient harms decreased by almost 40% from Q1 2019 (Jan-Mar) to Q3 2021 (Jul-Sep).

The decrease is largely driven by reductions in hypoglycaemic rescue, which comprise 69% of total inpatient harms. This trend tallies with the findings from the final NaDIA report (NaDIA 2019, Chart 2.2).

Notes:

1. Proportions and rates are derived from rounded values. Underlying counts between 1 and 7 are set to 5. All counts greater than 7 are rounded to the nearest 5.

2. Analysis covering April-Oct 2021 uses provisional data from Hospital Episode Statistics (HES) and core National Diabetes Audit (NDA).

3. Proportions and rates are calculated from the sum of nights in hospital during the period stated for people in the core NDA, where diabetes was diagnosed on or before admission. Day cases and same-day discharges are counted as zero days and are therefore excluded. For further information, see: Further information: Inpatient population with diabetes.

Chart 4.3 (below) shows that, although the rate of DFUs appears to follow a downward trend, there was no reduction in the rate of DKA and HHS. This also tallies with the findings from the final NaDIA report (NaDIA 2019, Charts 2.3-2.5).

Notes:

1. Proportions and rates are derived from rounded values. Underlying counts between 1 and 7 are set to 5. All counts greater than 7 are rounded to the nearest 5.

2. Analysis covering April-Oct 2021 uses provisional data from HES and core NDA.

3. Proportions and rates are calculated from the sum of nights in hospital during the period stated for people in the core NDA, where diabetes was diagnosed on or before admission. Day cases and same-day discharges are counted as zero days and are therefore excluded. For further information, see: Further information: Inpatient population with diabetes.