Table 3 Potential Steps for Facilitating Service Improvement in Diabetic / Pre-diabetic Patients Undergoing Cardiac Surgery

Step 1

Publication of detailed and specific guidelines regarding:

Pre-operative screening of all patients undergoing elective cardiac surgery and therapeutic intervention for Diabetes / pre-diabetes

Pre-operative target glycaemic criteria permitting elective surgery e.g. HbA_1c < 7.5%

Methods, triggers and duration of intra-operative and post-operative glycaemic control

Post-operative / pre-discharge target criteria of glycaemic control on ITU and ward e.g. blood glucose ≤12 mM pre-discharge

Early post-discharge follow up by family doctor / Diabetes specialist team to ensure ongoing good glycaemic control

Step 2

Establishment of a dedicated cardiac diabetic specialist team in every cardiac surgical unit to facilitate:

Pre-, peri-, post-operative and discharge glycaemic control and planning

Patient and professional education at all levels and communication with primary and community care services

Step 3

Establishment of specific national diabetic cardiac Surgical Care Improvement Project (SCIP) Europe-wide to include:

Introduction of relevant and appropriate performance quality measures e.g.:-

HbA_1c measurement in 100% of elective patients undergoing cardiac surgery

Pre-operative point of care fasting blood glucose of ≤8 mM in 95% of operated patients

Pre-operative HbA_1c value of < 7.5% in 95% of elective patients going for cardiac surgery

Median post-operative LOS of diabetic patients ≤1.0 day greater than median postoperative LOS for non-diabetic patients

Pre-discharge blood glucose range of 4–12 mM (day before discharge) in 95% of all patients going for cardiac surgery

Post-discharge review by diabetic specialist nurse or family doctor within 1 week in 95% of patients

Incidence of deep sternal wound infection for diabetic patient within the 95% CI of non-diabetic patient

A peri-operative glycaemic control multi-disciplinary working group in every cardiac surgical unit, responsible for monitoring and reporting SCIP adherence and compliance.