Inspiration: Implementing a pathway for people with diabetes who call for an ambulance

Inspiration: Implementing a pathway for people with diabetes who call for an ambulance

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Organisation: Health Innovation Network South London


The aim of the project is to implement a new referral pathway between London Ambulance Service and the providers of diabetes services in South London, for people with diabetes who have had a hypoglycaemic episode and who call for an emergency ambulance.

The issue is that the current referral pathway, implemented in 2012, is not achieving its aims of providing the best level of care for people with diabetes, and of reducing the number of hypoglycaemic episodes that London Ambulance Service is called to.

Brief Summary

This project is being led by a Darzi Fellow who started in September 2014, and who is a paramedic on secondment from the London Ambulance Service. The project team includes people who work part-time on this project and other projects, and includes: programme and project managers, specialist diabetes hospital consultants and AHPs, and GPs with an interest in diabetes.

It covers all of the South London CCGs.

The project began in April 2014 with an evaluation of the current London Ambulance Service hypoglycaemia referral pathway.

Following extensive data collection and analysis, the optimal pathway was designed for people with diabetes who have had a hypoglycaemic episode in the community. All the local partners, people with diabetes, representatives from Diabetes UK, and the London Ambulance Service were involved in the redesign process.

The project is about half way through the Darzi Fellow’s year, and is at a slightly different stage for each of the CCGs. Out of the twelve CCGs in South London, seven are progressing well and the following CCGs are expected to have new pathways in place by the summer of 2015:

  • Bexley
  • Bromley
  • Greenwich
  • Lambeth
  • Lewisham
  • Southwark
  • Sutton and Merton

The project has some concrete outcome measures:

  • Increase in percentage of referrals made from LAS to community providers
  • Reduction in number of calls made to respond to hypoglycaemic episodes
  • Reduction in number of people who call recurrently

The project team is working closely with London Ambulance Service to promote the clinical messages about the new pathway and encourage the crews to increase their referral rates.

With the redesign of the referral pathway there has been some challenges, such as:

  • Information governance for the data collection
  • Agreeing and deciding on the pathway for each of the CCGs
  • Educating all of the LAS staff about the importance of making the referral to the relevant provider

Area of work

In relation to the four foundations of our declaration, this project aims to:

  • Care is about me
  • Working as one team
  • Make London healthier and happier

Service user involvement?

We have involved people with diabetes and representatives of Diabetes UK throughout the project. For example, at least two people with diabetes have been to the redesign workshop; a representative of Diabetes UK has attended our fortnightly delivery meetings, and one of the project team has been to some local diabetes forums.

Advice for others

Focus on the impact of the changes you’re trying to make in order to keep on going and don’t expect results quickly.

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