Improving the outcomes for people with diabetes undergoing surgery: An observational study of the Improving the Peri-operative Pathway of People with Diabetes (IP3D) intervention

Aims: We evaluated the effectiveness of an intervention to improve the care of people with diabetes undergoing surgery when implemented across multiple organisations. Methods: This was an observational study using routinely collected data. Eight hospitals in England implemented the Improving the Peri-operative Pathway of People with Diabetes (IP3D) intervention, with pre-implementation data collected from 1st February to 31st July 2019 and post-implementation data collection within the period 1st February to 31st October 2021. Key elements were the use of a patient empowering peri-operative passport and the employment of a peri-operative diabetes specialist nurse. The primary outcome was the change in length of stay. Results: In total 1837 patients at pre-implementation and 1164 patients at post-implementation undergoing elective surgery were included. Pre- and post-implementation 23.8 % and 33.4 % of patients had day-case surgery respectively. For in-patients median length of stay decreased from 3.2 days (inter-quartile range 1.5-6.1) pre-implementation to 2.5 days (inter-quartile range 1.4-5.4) post-implementation. There were also significant improvements in patient experience, hypo- and hyper-glycaemic events, wound complications and diabetes related complications. Conclusions: The IP3D intervention has the potential to increase efficiency and reduce waiting lists for elective surgery on a nationwide basis.