Implementation strategies and benefits

Abstract

The implementation of a diabetes day hospital optimizes the care of complex patients through an outpatient model that prevents hospitalizations. It is necessary to establish which services will be provided, as well as clear inclusion and exclusion criteria for patients.

Its implementation is based on human resources management, the standardization of healthcare processes tailored to the needs of the referring facilities, and the conditioning of the necessary infrastructure, which includes adequate spaces and required technology.

A Diabetes Day Hospital is designed to care for situations of high clinical complexity that require intensive medical supervision or specialized education, but are not severe enough to justify an inpatient admission to a general ward.

A multidisciplinary team is required, consisting of diabetes specialists, diabetes nurse educators, nutritionists, podiatrists, mental health specialists, social services, and administrative staff. All must have appropriate training and a structured care and education program adapted to adult populations, pediatric populations, or both.

The professional team works in a coordinated manner to offer a rapid and efficient response to acute glycemic decompensations, such as: severe hyperglycemia, recurrent severe hypoglycemia, initiation of complex insulin therapy (for example, at the onset of type 1 diabetes), pregestational and gestational diabetes, diabetic foot management, perioperative care for decompensated patients, transition to technologies, etc.

An operational key is to maintain a flexible schedule that allows for the immediate reception of referrals from emergency departments or primary care. This avoids hospitalization with all its consequences or, in some cases, prevents the prolongation of hospital stays, thereby saving financial resources.

The day hospital not only stabilizes the patient clinically, but it is also a unique opportunity to provide or reinforce diabetes education for patients and their environment. This includes self-monitoring, prevention and treatment of hypoglycemia, decision-making based on glycemic profiles, and the use of available digital technology (continuous glucose monitoring, telemedicine for remote dose adjustment, and shared clinical records with primary care), empowering the patient and ensuring adherence for continuity of treatment.

It is necessary to design an objective and continuous evaluation model for the implemented strategy, using objective and measurable data (readmission rates, etc.), including the satisfaction of all stakeholders involved, in order to make the day hospital changes more efficient.

The main benefits of a diabetes day hospital focus on improving the patient's quality of life, optimizing the financial resources of the healthcare system, and guaranteeing agile, close, and safe clinical care.

Since there is no single format for a diabetes day hospital, its success lies in the flexibility to adapt the model to the specific needs and resources of each territory.