Using IT To Reduce The Stress Of A Diabetes Clinic
What Happens at a Diabetes Clinic? <ul><li>Screening for complications </li></ul><ul><li>Identification of problems </li><...
Why can diabetes clinics be difficult? <ul><li>History  </li></ul><ul><ul><li>Diabetes clinics are busy </li></ul></ul><ul...
New Referrals With Diabetes
Review Attendance
A lot of information to be gathered <ul><li>SIGN minimum data </li></ul>
 
Diabetes Team <ul><li>Nurses </li></ul><ul><ul><li>clinic, nurse specialists, auxiliary </li></ul></ul><ul><li>Dietician <...
Screening <ul><li>Biochemical </li></ul><ul><ul><ul><li>Hba1c </li></ul></ul></ul><ul><ul><ul><li>Renal function </li></ul...
Screening <ul><li>Retinal examination </li></ul><ul><li>VA </li></ul><ul><li>BP </li></ul><ul><li>Foot pulses and vibratio...
Potential problems <ul><li>Missed screening </li></ul><ul><li>Duplicated screening </li></ul>
Organisation <ul><li>Efficiency </li></ul>
IT - Useful or useless? <ul><li>More work </li></ul><ul><li>Increased time </li></ul><ul><li>Useless information </li></ul...
DOCTOR (4) SECRETARIES LAB PODIATRIST NURSE FILE SERVER IT DEPT
Lab Nurse Doctor Podiatrist Dietician IT Dept Secretaries Clinic summary GP Lab Nurse Doctor Podiatrist Dietician
 
Useful <ul><li>Quality </li></ul><ul><ul><li>Transparent  </li></ul></ul><ul><li>Ordering bloods according to protocol </l...
Secretary prints blood requests Patient arrives and booked in Phlebotomy Nurse (VA, weight +/- eye drops) Laboratory HbA1c...
How do we judge our performance? <ul><li>Audit </li></ul><ul><ul><li>Process </li></ul></ul><ul><ul><ul><li>screening </li...
Audit of screening
 
Diagnosis CHD Risk of > 30% 2 Year Follow Up <ul><li>Cardiovascular risk factors in </li></ul><ul><li>Those at the highest...
Diagnosis CHD Risk of > 30% 2 Year Follow Up Smoking status was unaffected despite advice issued at clinics
The Future 1 <ul><li>Local </li></ul><ul><ul><li>Link to eye photography </li></ul></ul><ul><ul><li>Link to primary care <...
The Future 2 <ul><li>Central funding and support for IT </li></ul><ul><ul><li>Report by the Working Group on IT to Support...
The Future 3 <ul><li>Scottish Diabetes Survey </li></ul><ul><ul><li>HDL (2000) 12 </li></ul></ul>
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How can you reduce the stress of running a diabetic clinic?

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How can you reduce the stress of running a diabetic clinic?

  1. 1. Using IT To Reduce The Stress Of A Diabetes Clinic
  2. 2. What Happens at a Diabetes Clinic? <ul><li>Screening for complications </li></ul><ul><li>Identification of problems </li></ul><ul><li>Intervention </li></ul><ul><ul><li>Prescribing </li></ul></ul><ul><ul><li>Referral for advice </li></ul></ul>
  3. 3. Why can diabetes clinics be difficult? <ul><li>History </li></ul><ul><ul><li>Diabetes clinics are busy </li></ul></ul><ul><li>Increasing numbers of patients </li></ul>
  4. 4. New Referrals With Diabetes
  5. 5. Review Attendance
  6. 6. A lot of information to be gathered <ul><li>SIGN minimum data </li></ul>
  7. 8. Diabetes Team <ul><li>Nurses </li></ul><ul><ul><li>clinic, nurse specialists, auxiliary </li></ul></ul><ul><li>Dietician </li></ul><ul><li>Podiatrist </li></ul><ul><li>Phlebotomist </li></ul><ul><li>Laboratory staff </li></ul><ul><li>Secretarial and receptionist </li></ul><ul><li>Physicians </li></ul>
  8. 9. Screening <ul><li>Biochemical </li></ul><ul><ul><ul><li>Hba1c </li></ul></ul></ul><ul><ul><ul><li>Renal function </li></ul></ul></ul><ul><ul><ul><li>Lipids </li></ul></ul></ul><ul><ul><ul><li>Microalbuminuria </li></ul></ul></ul><ul><ul><ul><li>Thyroid? </li></ul></ul></ul><ul><li>Protocol </li></ul>
  9. 10. Screening <ul><li>Retinal examination </li></ul><ul><li>VA </li></ul><ul><li>BP </li></ul><ul><li>Foot pulses and vibration perception </li></ul><ul><li>Protocol </li></ul>
  10. 11. Potential problems <ul><li>Missed screening </li></ul><ul><li>Duplicated screening </li></ul>
  11. 12. Organisation <ul><li>Efficiency </li></ul>
  12. 13. IT - Useful or useless? <ul><li>More work </li></ul><ul><li>Increased time </li></ul><ul><li>Useless information </li></ul><ul><li>Unfriendly screens </li></ul><ul><li>Information in but none out </li></ul><ul><li>Rubbish in rubbish out </li></ul><ul><li>Less work </li></ul><ul><li>Time saved </li></ul><ul><li>Useful information </li></ul><ul><li>Easy to use </li></ul><ul><li>Reports and audit </li></ul><ul><li>Sense checking </li></ul>
  13. 14. DOCTOR (4) SECRETARIES LAB PODIATRIST NURSE FILE SERVER IT DEPT
  14. 15. Lab Nurse Doctor Podiatrist Dietician IT Dept Secretaries Clinic summary GP Lab Nurse Doctor Podiatrist Dietician
  15. 17. Useful <ul><li>Quality </li></ul><ul><ul><li>Transparent </li></ul></ul><ul><li>Ordering bloods according to protocol </li></ul><ul><li>Download of biochemistry automatically </li></ul><ul><li>Reduced duplication if multiple users </li></ul><ul><li>Letter generation </li></ul><ul><ul><li>Summaries </li></ul></ul><ul><ul><li>Addresses </li></ul></ul><ul><ul><li>Information for all </li></ul></ul><ul><ul><li>Drug and condition lists </li></ul></ul>
  16. 18. Secretary prints blood requests Patient arrives and booked in Phlebotomy Nurse (VA, weight +/- eye drops) Laboratory HbA1c, cholesterol, U + E, Alb/creat ratio Physician (BP, feet, eyes) Nurse Specialist Dietician Podiatrist Letter to GP
  17. 19. How do we judge our performance? <ul><li>Audit </li></ul><ul><ul><li>Process </li></ul></ul><ul><ul><ul><li>screening </li></ul></ul></ul><ul><ul><li>Outcome </li></ul></ul><ul><ul><ul><li>BP </li></ul></ul></ul><ul><ul><ul><li>Lipids </li></ul></ul></ul><ul><ul><ul><li>HbA1c </li></ul></ul></ul>
  18. 20. Audit of screening
  19. 22. Diagnosis CHD Risk of > 30% 2 Year Follow Up <ul><li>Cardiovascular risk factors in </li></ul><ul><li>Those at the highest risk are </li></ul><ul><li>Being treated </li></ul><ul><li>35.0%  25.4% </li></ul><ul><li>Calculated lowest possible risk </li></ul><ul><li>For this group = 22.0% </li></ul><ul><li>What is not at target? </li></ul>
  20. 23. Diagnosis CHD Risk of > 30% 2 Year Follow Up Smoking status was unaffected despite advice issued at clinics
  21. 24. The Future 1 <ul><li>Local </li></ul><ul><ul><li>Link to eye photography </li></ul></ul><ul><ul><li>Link to primary care </li></ul></ul><ul><ul><ul><li>Podiatry, GPs </li></ul></ul></ul><ul><ul><li>Link to Lothian register </li></ul></ul>
  22. 25. The Future 2 <ul><li>Central funding and support for IT </li></ul><ul><ul><li>Report by the Working Group on IT to Support Shared Care for Diabetes </li></ul></ul>*This is very important*
  23. 26. The Future 3 <ul><li>Scottish Diabetes Survey </li></ul><ul><ul><li>HDL (2000) 12 </li></ul></ul>
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