Introduction: Diabetes is a known risk factor for increased morbidity and mortality in cardiothoracic patients. Adversities including increased rates of post-surgical infection, increased recurrence of cardiac events, and poorer long-term health outcomes in this population correlate with inflated costs to the health facility.

At John Hunter Hospital in Newcastle NSW, perceptions of increased cost and intensive efforts historically prevented optimising glycaemic control for critically ill cardiothoracic patients.

Aim: Streamlining diabetes care to cardiothoracic patients will improve clinical outcomes and workforce efficiency as evidenced by reduced readmission rates, improved glycaemic profiles, and enhanced capabilities of clinical staff.

Method: A retrospective analysis of patients admitted to John Hunter Hospital for Coronary Artery Bypass Graft (CABG) from July to December 2013 showed discrepancies in clinical outcomes between diabetic and non-diabetic patients. Diabetic patients were found to have suboptimal glycaemic management with poorer health outcomes. This consequentially increased readmissions to hospital. Implementation of guidelines outlining structured processes for glycaemic assessment and management in both elective and emergency CABG admissions was undertaken to address shortcomings in current clinical practice. A post implementation analysis was undertaken from July to December 2014.

Results: Readmission rates in diabetic patients decreased by 9.6% and inpatient length of stay (LOS) remained stable.  Comparatively, the non-diabetic group saw an increase in LOS by 4 days. The average HbA1c in diabetic patients prior to admission improved from 7.6% to 6.8%, and during hospitalisation improved from 7.7% to 6.7%. This improvement in glycaemic profile persisted for at least 6 months after discharge from hospital.

Increased workforce efficiency was demonstrated by improvement of appropriate referrals to endocrinology by 29% and to diabetes educators by 26%. There was a 200% increase of consultations attended by diabetes educators, and 128% increase of consultations attended by endocrinology to cardiothoracic patients from July 2013 to December 2014. These consultations were attended within 24hours with no adverse impact on inpatient LOS.

Conclusion: A structured approach to glycaemic management in cardiothoracic patients facilitates the early detection and management of dysglycaemia which improves clinical outcomes, enhances workforce capabilities, and decreases costs to the health facility.