Inpatient to Outpatient Transfer of Diabetes Care: Planning for an Effective Hospital Discharge |
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| Institution: | 1. Division of Endocrinology, Scottsdale, Arizona.;2. Clinical and Patient Education, Scottsdale, Arizona.;3. Division of Hospital Internal Medicine, Scottsdale, Arizona.;4. Department of Family Medicine, Scottsdale, Arizona.;5. Nursing Administration, Scottsdale, Arizona.;6. Department of Pharmacy, Scottsdale, Arizona.;7. Division of Quality Management Services, Mayo Clinic Arizona, Scottsdale, Arizona.;1. Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States;2. Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States;3. Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First Street SW, Rochester, MN 55905, United States;4. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, PO Box 208056, New Haven, CT 06520, United States;5. Section of Endocrinology, Department of Internal Medicine, Yale School of Medicine, PO Box 208020, New Haven, CT 06520, United States;6. OptumLabs, 1 Main Street, 10th Floor, Cambridge, MA 02142, United States;1. From the Division of Endocrinology and Metabolism, Georgetown University School of Medicine and Healthcare Sciences, MedStar Washington Hospital Center, MedStar Health Diabetes and Research Institutes, Washington, DC;2. MedStar Health Diabetes and Research Institutes, Washington, DC;3. MedStar Health Research Institute, Hyattsville, Maryland;4. MedStar Health Research Institute, Washington, DC;5. MedStar Diabetes Institute, Washington, DC;6. Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC.;1. From the Medical Director & Principal Investigator, Metabolic Institute of America, President, American College of Endocrinology, Tarzana, California;3. Chairman, Grunberger Diabetes Institute, Clinical Professor, Internal Medicine and Molecular Medicine & Genetics, Wayne State University School of Medicine, Bloomfield Hills, Michigan;4. Professor of Medicine, Emory University School of Medicine, Director, Endocrinology Section, Grady Health System, Atlanta, Georgia;5. Vice Chairman Endocrinology, Director, Cleveland Clinic Diabetes Center, Cleveland Clinic, Cleveland, Ohio;6. Clinical Associate Professor, UCSD School of Medicine, Director, AMCR Institute, Escondido, California;7. Director, Ochsner Diabetes Clinical Research Unit, Department of Endocrinology, Diabetes and Metabolism, Ochsner Medical Center, New Orleans, Louisiana;8. Boyd Professor and Professor of Medicine, Pennington Center, Louisiana State University, Baton Rouge, Louisiana;9. Medical Director, The Endocrine Clinic, P.C., Memphis, Tennessee;10. A.C. Mullins Professor & Director, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, Tennessee;11. Clinical Professor of Medicine, Division of Endocrinology, Touchstone Diabetes Center, The University of Texas, Southwestern Medical Center, Dallas, Texas;13. Senior Physician and Director, Lipid Clinic, Joslin Diabetes Center, Associate Clinical Professor of Medicine, Harvard Medical School, Boston, Massachusetts;14. Professor, Departments of Medicine, Biochemistry, and Molecular Biology, and Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas;15. Professor and Chair, Department of Nutrition Sciences, University of Alabama at Birmingham, Director, UAB Diabetes Research Center, Mountain Brook, Alabama;16. Professor of Medicine, UCSD, Chief, Section of Diabetes, Endocrinology & Metabolism, VA San Diego Healthcare System, San Diego, California;17. Professor of Medicine, University of Washington School of Medicine, Seattle, Washington;18. Senior Investigator, Joslin Diabetes Center, Professor of Medicine, Harvard Medical School, Brookline, Massachusetts;19. Assistant Professor of Medicine, Mayo Clinic, Rochester, Minnesota;20. Professor of Clinical Medicine, University of Miami, Miller School of Medicine, Miami, Florida, The Center for Diabetes & Endocrine Care, Hollywood, Florida;21. Physician Consultant, Sansum Diabetes Research Institute, Clinical Professor of Medicine, Keck School of Medicine of USC, Attending Physician, Santa Barbara County Health Care Services, Adjunct Professor Biomolecular Science and Engineering and Chemical Engineering, University of California Santa Barbara, Santa Barbara, California;22. Professor of Medicine, State University of New York Health Science Center at Brooklyn, Staten Island, New York;23. Director of Research, Division of Endocrinology, Diabetes and Bone Diseases, Mount Sinai School of Medicine, New York, New York;24. Clinical Professor of Medicine, University of Arizona College of Medicine, Banner Good Samaritan Multispecialty Group, Phoenix, Arizona;25. Professor of Medicine, Division of Endocrinology, Metabolism & Lipid Research, Washington University, St. Louis, Missouri;26. Clinical Professor of Medicine, Director, Metabolic Support, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York;27. Professor of Medicine and Obstetric and Gynecology, Keck School of Medicine of USC, Los Angeles, California;28. Clinical Associate Professor, University of California Los Angeles, Marina Del Ray, California;29. Endocrinology Associates, Houston, Texas;30. Assistant Clinical Professor, Mount Sinai School of Medicine, New York, New York, ProHealth Care Associates, Division of Endocrinology, Lake Success, New York;31. Clinical Professor, Medicine, Division of Endocrinology, Diabetes, Metabolism, University California Irvine School of Medicine, Irvine, California, Co-Director, Diabetes Out-Patient Clinic, UCI Medical Center, Orange, California, Director & Principal Investigator, Diabetes/Lipid Management & Research Center, Huntington Beach, California;32. Professor of Medicine/Pathology/Neurobiology, Director of Research & Neuroendocrine Unit, Eastern Virginia Medical Center, The Strelitz Diabetes Center, Norfolk, Virginia;33. Weill Cornell Medical College, Houston Methodist Hospital, Houston, Texas;34. Endocrine, Diabetes & Osteoporosis Clinic, Sterling, Virginia. |
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| Abstract: | ObjectiveTo review data on diabetes discharge planning, provide a definition of an effective diabetes discharge, and summarize one institution’s diabetes discharge planning processes in a teaching hospital.MethodsWe performed a MEDLINE search of the English-language literature published between January 1998 and December 2007 for articles related to the inpatient to outpatient transition of diabetes care. Regulatory guidelines about discharge planning were reviewed. We also analyzed our institution’s procedures regarding hospital discharge.ResultsWe define an effective diabetes discharge as one where the patient has received the necessary skills training and been provided with a clear and understandable postdischarge plan for diabetes care that has been clearly documented and is accessible by the patient’s outpatient health care team. Diabetes is one of the most common conditions managed in the hospital, yet how to transition a patient with diabetes to the outpatient setting is understudied, and the outcome of patients with diabetes after discharge is unknown. Strategies that can be used to ensure an effective diabetes discharge are early identification of patients in need of education, implementation of a clinical pathway, and clear instructions about medications and follow-up appointments at the time of discharge.ConclusionsEffective transfer of care from the inpatient to the outpatient setting remains a priority in the United States. Studies are needed to better define how best to ensure that patients with diabetes are successfully transitioned to ambulatory care. (Endocr Pract. 2009;15:263-269) |
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