Introduction and Objective: Readmission rates are higher for people with diabetes, but data and guidance for optimization of discharge management is lacking.
Methods: The annual T1DX-QI survey was conducted Sept-Nov 2024 with a response rate of 90% of 62 centers: 38 pediatric, 18 adult. Respondents answered questions about inpatient resources and practices. Response data was cleaned and summarized.
Results: Automatic consultation to an endocrine service was common in pediatrics (elevated HbA1c: 42%, diabetic ketoacidosis: 66%, elevated readmission risk score: 16%, other: 45%) but only used in 50% of adult centers. Knowledge of readmission rates for people with diabetes was low in adult centers, and use of risk calculators to predict readmission risk was low (pediatric 16%, adult 6%). Inpatient diabetes education is performed by a range of professionals: most commonly CDCES (82%) at pediatric centers and floor registered nurse (72%) or midlevel provider (72%) at adult centers. Inpatient initiation of CGM is more common at pediatric centers (66%) than adult centers (44%). Discharge order sets are common (peds 76%, adult 71%), but discharge checklists (peds 71%, adult 39%) and discharge coordinators (peds 37%, adult 11%) are rarer. Discharge medications are given in hand at 71% of pediatric centers and coverage confirmed in 28%. Lower prescription support was reported by adult centers: 24% give medications in hand, 18% use a central pharmacy, and 18% confirm insurance coverage before discharge. Average wait time to follow up appointments is within 2 weeks in 48% of pediatric centers. Adult centers reported 11% of visits within 2 weeks and 50% in 2-4 weeks.
Conclusion: While hospitalization is an opportunity for education and medication optimization, inpatient and post-discharge management of diabetes remains underemphasized—especially at adult centers. Quality improvement initiatives are needed to evaluate discharge tools and support services in reducing readmission rates and optimizing post-discharge diabetes care.
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