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Evaluation of a diabetes referral pathway for the management of hypoglycaemia following emergency contact with the ambulance service to a diabetes specialist nurse team
  1. A Walker1,
  2. C James2,
  3. M Bannister3,
  4. E Jobes4
  1. 1Mid Yorkshire Trust and West Yorkshire Metropolitan Ambulance Service, Wakefield, UK
  2. 2West Yorkshire Metropolitan Ambulance Service, Wakefield, UK
  3. 3Bradford City PCT, Bradford, UK
  4. 4Huddersfield Central PCT, Huddersfield, UK
  1. Correspondence to:
 A Walker
 Mid Yorkshire Trust and West Yorkshire Metropolitan Ambulance Service, Springhill, Wakefield 41 Industrial Park, Brindley Way, Wakefield, WF2 0XQ, UK; alison.walker{at}


Objectives: To evaluate the effectiveness of ambulance crew referral of patients treated for acute hypoglycaemia, to a diabetes specialist nurse (DSN) team. Patients were assessed by the ambulance service and did not attend an emergency department.

Methods: For a 3 month period patients were referred from two areas of West Yorkshire by the ambulance service to specialist diabetes teams. The DSNs contacted the patients within 7 days by telephone and arranged further review if necessary. Satisfaction questionnaires were sent to patients.

Results: Thirty eight patients were referred and all were reviewed by telephone; 30 (79%) also required a clinic review appointment. Warning signs of hypoglycaemia were identified by 21 (55%) patients, but 14 (37%) had none (three had incomplete data). Twelve patients had had a self-treated episode in the previous 6 months; nine patients had had three or more. Fifteen (39%) patients had called an emergency ambulance for similar reasons in the previous 6 months (27 “999” calls). Twenty patients (53%) had their drug treatment altered at a clinic appointment and 14 (37%) required ongoing review. Twenty six patients returned the satisfaction questionnaire; of these 88% agreed or strongly agreed that they had improved their understanding of hypoglycaemia and 73% felt more able to treat a hypoglycaemic episode in the future. Patient satisfaction with this care pathway was high.

Conclusions: The ambulance service can coordinate successful referral of patients with episodes of acute hypoglycaemia to a DSN-led service. Patients often required treatment review. They valued this service and felt more confident managing their diabetes.

  • DSN team, diabetes specialist nurse team
  • PCT, Primary Care Trust
  • SH, severe hypoglycaemia
  • ambulance service
  • diabetes
  • paramedics
  • referral
  • specialist nurse service

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  • Competing interests: none declared

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