Leading Better Value Care
Local vignette – Northern NSW LHD

Inpatient management of diabetes

Inreach model with access to specialist diabetes care – a clinician's perspective

By Michelle Culhane

23 Apr 2021 Reading time approximately

What is important to know about your service?

Across Northern NSW Local Health District (NNSWLHD) there are no staff specialist endocrinologists. Two endocrinologists cover The Tweed Hospital as visiting medical officers (VMOs), while Lismore Base Hospital has access to a physician with expertise in diabetes management. Access to the endocrinologists and the physician is via medical referral. More than 80% of nursing staff that work in NNSWLHD hospital facilities are either part-time or casual.

What organisational model do you use?

A structured inreach model that includes an interdisciplinary team of diabetes educators and dietitians who work with all clinicians, including diabetes resource nurses.

Identification and testing
leads to
Insulin management
leads to
Access to specialist care
leads to
Optimising health

What is special about the way care is delivered that is valuable for others to know?

The model delivers care in line with local clinical guidelines, which includes: diabetes resource nurses and an inpatient diabetes team, safer transfer of care to general practice through electronic discharge summaries, patient self-care, e-consult orders, staff education, standardised hypoglycaemia guideline, and the establishment of post-acute clinics for follow-up care. The model is in place in all facilities across NNSWLHD.

Nursing staff can refer to the diabetes educator, diabetes dietitian and pharmacist via a single team referral at the Tweed, Lismore, Maclean and Grafton hospitals. Other smaller facilities in NNSWLHD can also refer to the diabetes educator.

Diabetes resource nurses advocate and facilitate best practice in diabetes management within the inpatient setting. They support other staff in the hospital, advocating for early referral to diabetes services, role modelling appropriate care of patients with diabetes, and making sure the ward is up-to-date with changes in diabetes management. Support is provided by the directors of nursing across all hospitals and multipurpose sites.

A companion document describes options of organisational models for the management of diabetes in the inpatient setting. One option is access to a senior physician and an interdisciplinary team with expertise in diabetes management – this vignette describes the model from a local perspective.

How does it make a difference?

High risk patients are being identified on the wards and referred to diabetes services earlier for intervention. This increases involvement and satisfaction for both clinicians and patients.

What tips do you have for others?

  • Aim for standardisation in diabetes care across the local health district.
  • Be open-minded.
  • Potential diabetes resource nurses should have a special interest in diabetes to undertake a role that is structured, clearly defined, and with specific requirements or an educational package to achieve.

Back to top