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

From: Effect of glycaemic control on complications following cardiac surgery: literature review

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. HbA1c < 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.:-
HbA1c 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 HbA1c 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.