Background Surrey Memorial Hospital (SMH) serves one of the fastest growing cities in Canada. 12% of Surrey’s population has diabetes compared to 8% in all of British Columbia with 3,455 new cases diagnosed each year. 67% of patients discharged from SMH have diabetes and have a longer length of stay (LOS). The lack of timely, effective insulin teaching and discharge planning was found to be one of the barriers to timely discharges.

Objectives 1. To optimize the process and overcome barriers in teaching insulin and co-creating safe discharge.

2. To evaluate the impact of the new insulin teaching pathway on the length of stay with the aim to reduce the LOS from 12 to 11 days for inpatients newly started on insulin at SMH by September 30, 2020.

Methods In 2018, a multidisciplinary group including nursing educators, pharmacist, patient partner, and an endocrinologist, collaborated with other stakeholders using Model for Improvement. We developed insulin teaching toolkit and the Insulin Teaching Patient Pathway, a streamlined, pre-printed order set that ensures staff have the tools needed for insulin teaching and follow-up at the diabetes center.

Results LOS decreased from 12.4 to 8.7 days and showed sustainment through the COVID19 pandemic (figure 1).

Conclusions The initial project goal to decrease LOS has been sustained at SMH. Additional outcomes have been spread to other hospitals, executive leadership recognition and support, and the hiring of a full-time inpatient educator. Most importantly, the empowerment of patients and staff regarding diabetes education and insulin administration. Executive leadership buy-in and the frontline team’s ‘pull’ system were key to success.

• Download figure
• Open in new tab
• Download powerpoint

Abstract 19 Figure 1

Lengths of stay for newly insulin started patients