A new integrated care pathway for ambulance attended severe hypoglycaemia in the East of England: The Eastern Academic Health Science Network (EAHSN) model

作者：Sampson Michael^*; Bailey Marcus; Clark John; Evans Mark L; Fong Rebekah; Hall Helen; Hambling Clare; Hadley Brown Martin; Morrish Nick; Murphy Helen; Rayman Gerry A; Vithian Karunakaran; Winocour Peter; Harries Amanda

来源：Diabetes Research and Clinical Practice, 2017, 133: 50-59.

DOI：10.1016/j.diabres.2017.08.017

• Severe hypoglycaemia
• Ambulance
• Diabetes
• Insulin
• Emergency

Aims: We developed a new clinical integrated pathway linking a regional Ambulance Trust with a severe hypoglycaemia (SH) prevention team. We present clinical data from the first 2000 emergency calls taken through this new clinical pathway in the East of England.
Methods: SH patients attended by Ambulance crew receive written information on SH avoidance, and are contacted for further education through a new regional SH prevention team. All patients are contacted unless they actively decline.
Results: Median age (IQR) was 67 (50-80) years, 23.6% of calls were for patients over 80 years old, and patients more than 90 years old were more common than 20-25 year olds in this population. Most calls were for patients (84.9%) who were insulin treated, even those over 80 years (75%). One - third of patients attended after a call were unconscious on attendance. 5.6% of patients in this call population had 3 or more ambulance call outs, and they generated 17.6% of all calls. In total, 728 episodes (36.4%) were repeat calls. Insulin related events were clinically more severe than oral hypoglycaemic related events. Patients conveyed to hospitals (13.8%) were significantly older, with poorer recovery in biochemical hypoglycaemia after ambulance crew attendance. Only 19 (1%) opted out of further contact. Patients were contacted by the SH prevention team after a median 3 (0-6) days. The most common patient self - reported cause for their SH episode was related to perceived errors in insulin management (31.4%).
Conclusions: This new clinical service is simple, acceptable to patients, and a translatable model for prevention of recurrent SH in this largely elderly insulin treated SH population.

• 出版日期2017-11