Table 1 Description of the three LBVC initiatives and audit and feedback implementation strategy targeting inpatient variation in care
Initiative | Clinical priorities | Objectives | Implementation strategy |
|---|---|---|---|
Chronic heart failure and chronic obstructive pulmonary disease | • Timely cardiology review and access to investigations • Evidence-based pharmacological treatment, fluid management, and oxygen therapy • Spirometry to confirm and assess severity of COPD exacerbation • Delivery of oxygen and non-invasive ventilation • Timely referral to a multidisciplinary heart failure management program or pulmonary rehabilitation; standardised communication to support transfer to the community; identification of advanced heart failure and COPD for palliative care | • Improve health outcomes and efficient service delivery • Reduce unwarranted clinical variation • Optimise patient and carer experience • Increase the education, resources and support provided to people | • Local clinicians and managers review practice and implement strategies to align routine care with best practice • A range of responses is expected and encouraged. Localised improvement plans monitored • Systematisation of local processes to detect and address unwarranted clinical variation |
Inpatient management of diabetes mellitus | • BGLa test taken in the emergency department and a current HbA1c recorded early in the medical file • A minimum of four BGL checks in the first 24 h of admission, and regular BGL monitoring for patients requiring insulin. A basal-bolus-supplemental insulin regimen is considered for all patients requiring subcutaneous insulin • Timely and appropriate access to specialist care if required • A diabetes management plan with standardised communication to support transfer for ongoing management | • Provide support for audit and feedback, continuous improvement, and benchmarking • Increase identification of people with diabetes in hospitals who require insulin • Increase clinical staff knowledge and skills to provide best-practice care • Facilitate access to specialised diabetes care • Reduce insulin prescribing errors • Reduce hyper- and hypo-glycaemic episodes and other insulin-related adverse events • Reduce complication rates for people with diabetes requiring insulin • Reduce hospital length of stay for people with diabetes who require insulin • Improve the patient and carer experience | • A capability-building strategy to support best practice management of people with diabetes who require insulin including implementation of a subcutaneous insulin chart • Define best practice management of people in hospitals with diabetes who require insulin • Advice and support for local audits to support feedback, continuous improvement, and benchmarking |