Using it to reduce the stress of a diabetes clinic
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Using IT To Reduce The Stress Of A Diabetes Clinic. What Happens at a Diabetes Clinic?. Screening for complications Identification of problems Intervention Prescribing Referral for advice. Why can diabetes clinics be difficult?. History Diabetes clinics are busy

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Presentation Transcript

What happens at a diabetes clinic l.jpg
What Happens at a Diabetes Clinic?

  • Screening for complications

  • Identification of problems

  • Intervention

    • Prescribing

    • Referral for advice


Why can diabetes clinics be difficult l.jpg
Why can diabetes clinics be difficult?

  • History

    • Diabetes clinics are busy

  • Increasing numbers of patients





Diabetes team l.jpg
Diabetes Team

  • Nurses

    • clinic, nurse specialists, auxiliary

  • Dietician

  • Podiatrist

  • Phlebotomist

  • Laboratory staff

  • Secretarial and receptionist

  • Physicians


Screening l.jpg
Screening

  • Biochemical

    • Hba1c

    • Renal function

    • Lipids

    • Microalbuminuria

    • Thyroid?

  • Protocol


  • Screening10 l.jpg
    Screening

    • Retinal examination

    • VA

    • BP

    • Foot pulses and vibration perception

    • Protocol


    Potential problems l.jpg
    Potential problems

    • Missed screening

    • Duplicated screening


    Organisation l.jpg
    Organisation

    • Efficiency


    It useful or useless l.jpg

    More work

    Increased time

    Useless information

    Unfriendly screens

    Information in but none out

    Rubbish in rubbish out

    Less work

    Time saved

    Useful information

    Easy to use

    Reports and audit

    Sense checking

    IT - Useful or useless?


    Slide14 l.jpg

    LAB

    SECRETARIES

    DOCTOR (4)

    FILE SERVER

    NURSE

    PODIATRIST

    IT DEPT


    Slide15 l.jpg

    Nurse

    Lab

    Doctor

    IT Dept

    Secretaries

    Podiatrist

    Dietician

    Clinic summary

    Podiatrist

    GP

    Lab

    Dietician

    Nurse

    Doctor


    Useful l.jpg
    Useful

    • Quality

      • Transparent

    • Ordering bloods according to protocol

    • Download of biochemistry automatically

    • Reduced duplication if multiple users

    • Letter generation

      • Summaries

      • Addresses

      • Information for all

      • Drug and condition lists


    Slide18 l.jpg

    Secretary prints blood requests

    Patient arrives and booked in

    Nurse

    Specialist

    Phlebotomy

    Laboratory

    HbA1c, cholesterol, U + E, Alb/creat ratio

    Dietician

    Nurse (VA, weight +/- eye drops)

    Podiatrist

    Physician (BP, feet, eyes)

    Letter to GP


    How do we judge our performance l.jpg
    How do we judge our performance?

    • Audit

      • Process

        • screening

      • Outcome

        • BP

        • Lipids

        • HbA1c



    Diagnosis chd risk of 30 2 year follow up l.jpg
    Diagnosis CHD Risk of > 30%2 Year Follow Up

    Cardiovascular risk factors in

    Those at the highest risk are

    Being treated

    • 35.0%  25.4%

      Calculated lowest possible risk

      For this group = 22.0%

    • What is not at target?


    Diagnosis chd risk of 30 2 year follow up23 l.jpg
    Diagnosis CHD Risk of > 30%2 Year Follow Up

    Smoking status was unaffected despite advice issued at clinics


    The future 1 l.jpg
    The Future 1

    • Local

      • Link to eye photography

      • Link to primary care

        • Podiatry, GPs

      • Link to Lothian register


    The future 2 l.jpg
    The Future 2

    • Central funding and support for IT

      • Report by the Working Group on IT to Support Shared Care for Diabetes

    *This is very important*


    The future 3 l.jpg
    The Future 3

    • Scottish Diabetes Survey

      • HDL (2000) 12


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