Background
During the COVID-19 pandemic, many areas of medicine transitioned to virtual care to reduce viral transmission. For patients admitted to hospital, this included diabetes education (DE). Shifting to a virtual model for insulin teaching, in particular, created new challenges for our inpatient DE team.
Methods
We advanced a quality improvement project to improve the efficiency of virtual insulin teaching through the COVID-19 pandemic at London Health Sciences Centre. Our primary aim was to reduce the mean time between DE referral to successful inpatient insulin teach by 0.5 days. We implemented a new DE electronic order set that included a detailed referral request (PDSA-1). We added a streamlined method of insulin pen delivery to the ward for teaching (PDSA-2), followed by the inclusion of patient-care facilitators in the teaching process (PDSA-3). We captured the percentage of successful insulin teaches and readmissions to hospital as our balancing measure, and the percentage of successful insulin pen deliveries during virtual teaching as a process measure.
Results
Between April 2020 and September 2021, the inpatient DE team completed 307 insulin teaches: 150 were in-person, 157 were virtual. The average age of patients was 57 years (SD=16), 63% were male, and the majority (74%) had type 2 diabetes. Our tests of change improved the efficiency of virtual insulin teaching during the pandemic by 0.27 days (see Figure 1) without negative consequences (see Figure 2).
Conclusion
We improved the efficiency of virtual inpatient teaching at LHSC. However, in-person DE remained the most efficient way to successfully teach patients during hospitalization.
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