PA Hospital has officially launched its first Perioperative Diabetes Optimisation Service this May, thanks to a dedicated team of clinicians at the Diabetes and Endocrinology Department.
Housed at the Pre-Admissions Clinic, the team is made up of Staff Specialist Endocrinologist Dr Ben Sly, Diabetes Nurse Educator Monica Xie, and Specialist Diabetes Dietitian Lindsey Webb.
Launched as a 12-month pilot, the Perioperative Diabetes Optimisation Service supports the delivery of new national guidelines* for the surgical and procedural management of people living with diabetes who are planned for elective surgery.
Importantly, the team identified the need for a customised diabetes service that lowers the risk of clinical delays and postoperative diabetes-related complications, by proactively addressing diabetes management in the lead-up to surgery, and facilitating early postoperative diabetes review for higher-risk patients.
“Elevated glucose levels pre-surgery are the strongest predictor of glucose levels postoperatively. It is well established that both high and low glucose levels during hospital admission, particularly post-operatively are associated with worse outcomes and longer length of stay,” Dr Sly explained.
“Our goal is to identify people having elective surgery who have diabetes and are at higher risk of perioperative diabetes-related complications, and to provide them personalised MDT management recommendations in order to optimise glucose levels pre-surgery. In doing this, we are hopeful that we can improve outcomes and the experience for the person with diabetes, and contribute to better in-hospital glucose levels which may result in a reduction in clinical delays and minimising risk of diabetes-related complications.”
From referral to post-op, the service aims to deliver efficient, holistic care that’s tailored to the perioperative timeline. With capacity to see patients on short notice both in-person and via telehealth, the service allows the team to perform repeat reviews in the lead-up to surgery.
“Often there’s only a limited time after surgical booking. Having a specific model of care and workflow to allow that intense pre-surgery assessment is essential to servicing the large volume of people with diabetes requiring surgery at PAH. This complements existing diabetes services within Metro South and the wider Southeast Queensland region.”
Running full-day clinics every Thursday with additional Dietitian support on Tuesdays, Dr Sly says the service has had a productive start.
“The people we've seen to date are grateful to have access to a service that offers dedicated attention to their diabetes pre-surgery, and they feel confident in the recommendations and plans we’ve provided. This improves the overall experience during what can be a stressful time.”
Accepting referrals from all internal and external clinicians, the Perioperative Diabetes Optimisation team has their sights set on growing the service into a permanent fixture at PAH.
“We’re encouraging all surgical units who are booking elective surgery for people with diabetes to consider referring them to our service. We are happy to see everyone with T1DM or those with T2DM with Hba1c >8.5%, on insulin, with a history of hypoglycaemia, or First Nations people with diabetes.
“The more people we see, the greater impact we can have on patients, our surgical units and the hospital as a whole.”
To make a referral to the Perioperative Diabetes Optimisation Service please contact the team at: diabperiopPAH@health.qld.gov.au
*Published by the Australian Diabetes Society and Australian and New Zealand College of Anaesthetists in 2022, the guidelines for the surgical and procedural management of patient with diabetes have been locally adapted and published by the PAH team for use across Metro South Health.