COVID-19: how we adapted our diabetes service to provide seven-day-a-week, remote care
The changes that will remain post-pandemic and tips for adapting other services
At Solent NHS Trust, the community diabetes specialist team provides advice, guidance and support for adults who are living with diabetes in Southampton.
Most of our referrals come from primary care, district nursing and acute hospital discharges, but we accept referrals from any healthcare professional requiring our input.
Structure of a community diabetes specialist team before the pandemic
The services we provide include:
- Multidisciplinary (MDT) clinics.
- Diabetes specialist nurse support and guidance.
- Education programmes for health professionals.
- Structured education for those newly diagnosed with type 1 or type 2 diabetes.
- Refresher education sessions to support people living with diabetes.
- Support for the young person’s clinic and the transition from paediatric to adult care.
Before COVID-19, our service delivery was entirely face to face or on the telephone. Education sessions were run in groups of up to 20 participants, with appointments at a clinic.
COVID-19 demanded a rapid overhaul of routine diabetes services
During the early stages of the pandemic, we quickly realised this was all about to change. The acute hospital sector was facing intense pressures from COVID-19 and our thoughts turned to how we could provide support.
On 1 April, one of our five diabetes specialist nurses was redeployed to work at the local hospital – University Hospital Southampton (UHS) – to help support early discharges from the acute setting to our community team.
Additional support was provided via a discharge hotline, a direct line from UHS to our service, which enabled patients to be discharged sooner.
We thought that discharging patients earlier than usual would mean our referral rate would skyrocket, which it did. We had also learned from other countries that people living with diabetes are at higher risk of complications from COVID-19, so knew our knowledge and skills would be in high demand.
Our extended seven-day service developed online support and education packs
We therefore extended our service from its usual Monday to Friday to seven days a week.
During the development stages of providing seven-day cover, we had to make some dramatic changes to our current service. All our education sessions for health professionals and patients were terminated along with our diabetes specialist nurse clinics.
We started working 80% of our time from home, and our patient caseload was risk stratified and rated as red, amber or green. Those categorised as green were contacted to inform them that their routine care would be temporarily disrupted, as reducing contact with these patients allowed us to focus on the demands from hospital discharges and focus on admission avoidance.
Education packs were sent to all the patients on our waiting lists for the course they would have been attending. The packs included signposts to online courses, videos and websites and details for the Diabetes UK helpline.
Training for primary care nurses helped to reduce demand on local services
The team also developed a pack for primary care nurses to help them provide online support for patients who were starting insulin therapy. We worked with Southampton City Clinical Commissioning Group to develop guidance for oral medication adjustments and when and how to initiate insulin.
The aim was to avoid unnecessary hospital admissions and reduce demand on us as the local diabetes service. Ensuring support for all services was vital if we were to tackle the pandemic efficiently from all angles.
‘Virtual sessions are the largest service adaptation to arise from the COVID-19 pandemic. They offer patients more choice and can save time for patients and healthcare professionals’
As all of our face-to-face appointments were cancelled, we had to quickly become accustomed to using virtual methods of consultation using platforms such as Zoom and Skype. For patients who do not have the technology or skills to use video consultations, we offer telephone calls instead.
Using virtual methods of communication has been well accepted by the majority of our patients – a small patient survey showed they are more than happy with virtual consultations, although some of us health professionals have found this new way of working more difficult.
As the pressures from COVID-19 start to reduce, we have been able to reinstate some of our ‘paused’ services. While we continue to work from home, the use of video consultations has enabled us to restart our MDT sessions virtually and we are able to have four health professionals from four different locations in one virtual appointment.
Top tips for adapting a service
Listen to other healthcare professionals and learn from their ideas or innovations. What can you replicate that has worked well for others?
Work with local services, gain insight from a variety of sources and collaborate where possible
Gain feedback from patients If they like the new ways of working, then it will work. Put aside your own ideas of how things used to be and listen to feedback
Support your team Keep them updated with changes as promptly as possible. Let them know that although change can be hard, it sometimes forces us to find better ways of working
Prioritise needs These may change over time, so the service will need to adapt to meet the most significant demands.
Long-term changes to diabetes care service delivery
After realising the benefits of delivering virtual group education sessions, we are now in the planning stages to start delivering these sessions long term. But we are conscious that not everyone will want to access education in this way, or be able to, so we will continue to offer either virtual or face-to-face sessions for education and appointments.
Virtual sessions are the largest service adaptation to arise from the COVID-19 pandemic. They offer patients more choice and can save time for patients and healthcare professionals. The discharge hotline we set up with the hospital also worked well and as we had positive feedback from the acute sector, we plan to continue to accept referrals in this way once the COVID-19 pandemic is over.
The most important people are our patients – if feedback shows they like these new ways of working, we will continue to use them.
Emma Ives is diabetes specialist nurse and service manager for Solent NHS Trust's community diabetes specialist team