Out-of-office hours nurse-driven acute telephone counselling service in a large diabetes outpatient clinic: A mixed methods evaluation

Objective: To map the usage of out-of-office hours acute telephone counselling (ATC) provided by diabetes specialist nurses (n = 18) for diabetes patients to explore potentials for improvement. 

Methods: A mixed methods study involved mapping of ATC-usage during 6 months and a retrospective audit of frequent users. 

Results: Altogether, 3197 calls were registered that were related to 592 individual patients, corresponding to 10% of the population. Proportionally more users suffered from type 1 diabetes (p<0.001). ATC-users' mean HbA<inf>1c</inf> was 8.8% (73mmol/mol) compared to 8.1% (65mmol/mol) for all patients attending the clinic (p<0.001). Hyperglycaemia was the most frequent reason for calling. The use of ATC likely prevented 15 admissions. More than half of the calls came from general nurses based in the community (n=619) and general nurses and nursing assistants based in care homes (n=1018). The majority (75%) of patients called less than five times. However, 8% called 16 times or more accounting for 52% of all calls. A retrospective audit identified them as physically and/or psychologically fragile patients. 

Conclusion: Hyperglycaemia was the most frequent reason for calling, and insulin dose adjustment the most frequent advice given. 

Practice implications: Frequent users identified need additional support.