National Diabetes Inpatient Safety Audit (NDISA) 2018-2021

The National Diabetes Inpatient Safety Audit (NDISA) looked at the provision of inpatient services using the Integrated Specialist Services Structures Survey (ISSSS, abbreviated to ISS), a National Diabetes Audit (NDA) questionnaire which asks healthcare providers whether they have put in place structures and systems of care for people with diabetes recommended by the Getting It Right First Time (GIRFT) programme. The ISS was distributed to healthcare providers in England and Wales in October 2021.

The inpatient section of the ISS is comprised of questions on 17 aspects of inpatient care delivery identified as important by the 2018 Diabetes UK report: Making Hospitals Safe for People with Diabetes. The results of 11 of the 17 ISS questions are included in this report, relating to 6 GIRFT recommendations.

96 providers responded to the ISS (Table 3.1, below). This report includes data from the 85 ISS responders which provide acute inpatient medical care¹: 82 NHS trusts in England and 3 local health boards in Wales (LHBs). There are 138 acute providers in England² and 7 in Wales³, so the overall ISS response rate is 59% (85 of 145).

Notes:

1. Acute care includes active short-term hospital treatment for severe injury, illness, urgent medical conditions, or recovery from surgery.

2. See NHS England: Urgent and Emergency Care Daily Situation Reports 2021-22.

3. 7 local health boards.

Table 3.1: Submitters to the ISS, England and Wales, October 2021

GIRFT recommendation 5:

All healthcare providers must have a dedicated multi-disciplinary team of specialist diabetes inpatient practitioners (MDiTs) as indicated in the NHS Long Term Plan (3.81). Healthcare providers should work towards providing base level specialist diabetes cover at weekends where this does not exist.

Table 3.2 (below) shows that:

• 32% (27 of 85 responders) had an MDiT team and already provide diabetes cover on weekends.
• A further 27% (23 of 85) had an MDiT team and are planning to provide diabetes cover on weekends, making 59% (50 of 85) in total.

Table 3.2: Proportion of healthcare providers meeting GIRFT recommendation 5:

Dedicated MDiTs: provision and weekend cover (actual or planned),  England and Wales, October 2021

GIRFT recommendation 6:

The MDiT should meet regularly to discuss day-to-day errors and safety issues, and report to a quarterly provider-level diabetes safety board which reviews the overall quality of the inpatient service, with support from IT, based on incident reporting, local and national audits of patient harms, diabetes medication errors, length of stay and readmissions.

Table 3.3 (below) shows that: 44% (37 of 85) of responders fully met GIRFT recommendation 6.

Table 3.3: Proportion of healthcare providers meeting GIRFT recommendation 6:

Dedicated MDiTs: meeting and reporting, England and Wales, October 2021

GIRFT recommendation 7: All healthcare providers should have a robust system to identify all people with diabetes on admission to hospital, including emergencies and elective and non-elective surgery, and a triage system to identify those at risk and rapidly refer them to the diabetes team. This should be an electronic system, integrated with web-linked blood glucose (BG) meters which provide an alert system for staff when any out-of-range reading is recorded.

Table 3.4 (below) shows that 27% (23 of 85) of responders fully met GIRFT recommendation 7.

Table 3.4: Proportion of healthcare providers meeting GIRFT recommendation 7:

Identifying diabetes on admission and ensuring rapid referral, England and Wales, October 2021

Table 3.5: Proportion of healthcare providers meeting GIRFT recommendations 8, 9 and 10:

Reducing insulin errors, improving care through perioperative pathways and supporting self-management in hospital, England and Wales, October 2021