Up to 100,000 ambulance 999 call outs are made each year in the UK for severe hypoglycaemia, with up to 10,000 a year in the East of England. Many of these calls are made repeatedly by the same patients, and many are preventable.
- Every year, ambulance crews in the East of England respond to nearly 10,000 emergency call outs for diabetes emergencies, mostly with severe hypoglycaemia. Nearly all are managed by ambulance crew alone using a ‘see and treat’ policy without transfer to A&E.
- Cost estimates for this activity suggest a tariff and indirect cost of £10.6m over five years, of which much should be preventable with appropriate education, as hypoglycaemia can be avoided through effective self-management. However, these patients do not receive additional support.
- In this unique pathway, the attending ambulance crew give the patient a hypo avoidance leaflet designed by the Clinical Study Group. The patient is then referred, with their consent, to the hypo pathway. The patient is given three working days to opt out. Details of their hypo episode are then sent securely to one of the project’s clinical educators or project managers who will contact the patient to arrange an education session at their local GP practice or their own home.
- From December 2014 to April 2016, 2358 patients have been referred to the hypo pathway. Only 22 patients have actively opted out.
- To support the pathway, six large scale education sessions were held across the region and the East of England Ambulance Service NHS Trust (EEAST) crew were invited to attend to enhance their existing knowledge on diabetes.
- The project team have visited over 35 ambulance stations and over 1600 crew have either attended an education session or received educational materials regarding the hypo pathway. Crew training is ongoing across the region with community pharmacists now attending.
- The EEAST has 2600 emergency op staff and almost 1200 of these crew have made one or more referrals to the hypo pathway.
- 75,000 leaflets have been distributed across the 742 community pharmacies in the region. The new pharmacy leaflet offers advice on hypoglycaemia (hypos) and diabetes medication. The leaflets are now being used in Medicine Use Reviews and New Medicine Service consultations with patients. They enable the project to reach patients who might not be in regular contact with their GP or an outpatient clinic and may otherwise be missed.
- The pathway has led to better integrated care for patients as both primary and secondary care teams are informed of the patient’s episode. Previously, these teams are not consistently made aware of these events.
“With nearly 10,000 ambulance call outs a year, for diabetes emergencies each year treating people for severe hypoglycaemia puts a lot of strain on the East of England ambulance service as well as emergency departments and hospital wards. We now have a unique integrated pathway between the ambulance trust and primary and secondary care that delivers additional education to all these patients, and is linked to mass educational programmes for patients, ambulance crew and clinicians. We estimate the total cost of severe hypoglycaemia in the eastern area as about £1.05 million direct tariff costs. If we can reduce call outs by 20%, we will cover the cost of the programme.”
Professor Mike Sampson, Consultant in Diabetes and Chair of the Diabetes Clinical Study Group