ESPE Abstracts

Introduction: Currently in Ireland, the majority of children are admitted to hospital for education at initial diagnosis, regardless of diabetic ketoacidosis (DKA) status. ISPAD 2022 suggests that outpatient management for metabolically stable patients is a feasible management option if adequate resources are available. This study assesses the feasibility of such management in the University of Limerick (UHL) Paediatric Department by quantifying the care and education provided to children and families following a T1D diagnosis over the past 8 years.

The objectives were 1. to explore how many children might have been spared a prolonged inpatient stay 2. to estimate the bed-days and costs of the admissions that might have been prevented if ambulatory care for paediatric diabetes education was available at UHL during this time period.

Methods: The study includes all children and adolescents between 0 and 15.99 years diagnosed with T1D between June 4^th 2015 and June 3^rd 2023. Estimated bed days savings were calculated from retrospective data using the following criteria: days of stay during which the child had metabolic stability; no clear social or family reasons why inpatient education was required; and distance from hospital. Data was collected retrospectively from clinic charts, including data pertaining to admission length, complications, intensive care unit (ICU) or paediatric high dependency unit (PHDU) admission, patient address (town only), age at diagnosis, family history of T1D, and any social concerns flagged on admission. Data was collected using Microsoft Excel and analysed using Excel, Minitab and OpenStax.

Results: 182 individuals were included in this study and eligibility for ambulatory management was assessed for those diagnosed as metabolically stable and those in DKA. Assuming one-night initial admission for those metabolically stable at diagnosis and three nights for those in DKA (without PHDU/ICU admission), a total of 535 bed days would have been saved across the study period, averaging 67 bed days annually.

Discussion: In an era of hospital overcrowding and in the effort to provide family-centred care, exploration of ambulatory care model feasibility is increasingly important. This study demonstrates that ambulatory care is a feasible option for UHL paediatric department and would result in a considerable saving of bed-days, cutting admission costs with no projected impact on diabetes care. It would have to be conducted only in the context of adequate resources and with return to usual diabetes care in the event of complications but is an avenue of care worth exploring further.