Data collection for study: Open Publication date: Winter 2018 (tbc)
The aim of this study is to identify and explore remediable factors in the process of care in the peri-operative management of surgical patients with diabetes across the whole patient pathway from referral for surgery (elective) or admission to hospital (emergency) to discharge from hospital.
To examine organisational structures, processes, protocols and care pathways in hospitals from pre-admission through to discharge or death
To identify avoidable and remediable factors in the management of patients:
admitted (as an elective or emergency admission) with a diagnosis of diabetes mellitus
who have had a major operation (minor procedures to be excluded - OPCS codes listed below)
and who have had a planned overnight stay of at least one night post surgery, focusing on the following areas of care:
Timing, assessment (including pre-assessment and optimisation for elective patients) and urgency of admission/referral
Appropriate documentation, record sharing and management of diabetes mellitus
Multi-disciplinary review and follow-up throughout admission
Escalation of care decisions and planning including step down from critical care and enhanced recovery after surgery
Management of nutrition, fluids, critical incidents and medications
Management of delays in the process, and risk assessment
Appropriate discharge planning, communication to primary care including relevant information in the discharge letter, and planned follow-up
Organisational aspects of the pathways of care of elective and emergency patients with diabetes including aspects of staff training, patient education, administration of medicine and the management of day surgery.
All adult patients (aged 16 and older) that were admitted (either as an emergency or elective admission) who have a diabetes mellitus diagnosis (ICD10 code E10.0-E11.0) who have had a major operation with a length of stay of at least one night post surgery between the time frame 1st February 2017 – 31st March 2017.
All obstetric cases
All day cases
The following minor procedures listed as the primary code:
ICD10 code Description of code
A52 Therapeutic: epidural injection
A55 Diagnostic spinal puncture
A83 Electroconvulsive therapy
E48 Therapeutic fibreoptic endoscopic operations on lower respiratory tract
E49 Diagnostic fibreoptic endoscopic operations on lower respiratory tract
G16 Diagnostic fibreoptic endoscopic examination of oesophagus
G45 Diagnostic fibreoptic endoscopic examination of upper gastrointestinal tract
G47 Intubation of stomach
H22 Diagnostic endoscopic examination of colon
H25 Diagnostic endoscopic examination of lower bowel using fibreoptic endoscope
H28 Diagnostic endoscopic examination of sigmoid colon using rigid sigmoidscope
J13 Diagnostic percutaneous operation on liver
J43 Diagnostic endoscopic retrograde examination of bile duct and pancreatic duct
J44 Diagnostic endoscopic retrograde examination of bile duct
J45 Diagnostic endoscopic retrograde examination of pancreatic duct
J67 Diagnostic percutaneous operation on pancreas
K49 Transluminal balloon angioplasty of coronary artery
K51 Diagnostic transluminal operation on coronary artery
K58 Diagnostic transluminal operation on heart
K60 Cardiac pacemaker system introduced through vein
K63 Contrast radiology of heart
K65 Catheterisation of heart
K68 Drainage of pericardium
L86 Injection into varicose vein of leg
M47 Urethral catheterisation of bladder
R01 – R35 Female genital tract associated with pregnancy, childbirth and puerperium
S09 Photodestruction of lesion of skin
S13 Punch biopsy of skin
S15 Other biopsy of skin
S41 & S42 Suture of skin
S43 & S44 Removal of material from skin
S50 – S53 Introduction of material into subcutaneous tissue/skin
T12 Puncture of pleura
T43 Diagnostic endoscopic examination of peritoneum
Y70 – Y90 Methods of operation not otherwise classifiable
Z01 – Z94 Subsidiary classification of sites of operation
Patient identifier spreadsheets will be disseminated in May 2017. The spreadsheet can be downloaded from the Download Links section on the left.
Clinical questionnaire and case notes
To be disseminated in July/August 2017.
This questionnaire will collect data on organisational aspects of care at your site that relate to this study. We ask that the Local Reporter liaise with the relevant person(s) that can accurately complete the questionnaire.
We are currently recruiting Case note Reviewers for this study, please view more details about this role in the Download Links section of the page.
This webpage is updated regularly, so please check back for more information shortly.