Table 4 Oxford Heart Centre Diabetes Care Pathway

• Routine pre-operative diabetic screening for all cardiac surgical elective patients (HbA_1c). Via GP or part of Pre Assessment Clinic(PAC)

• Routine diabetic screening for all cardiac surgical urgent in-patients (HbA_1c)

• Point of care diabetic specialist team review of all diabetic, OR selectively identified “High Glycaemic Risk” cardiac surgical patients

• Automatic / mandatory ITU, ward, point of ITU discharge and pre-hospital discharge diabetic specialist team review of all diabetic, OR selectively identified “High Glycaemic Risk” cardiac surgical patients

• Automatic / mandatory GP or specialist nurse post-discharge follow up arrangement on agreed day e.g. day 4

• Routine pre-operative blood glucose measurement on admission of all surgical patients

• Establishment of a glycaemic control working group responsible for regular monitoring, auditing and presenting glycaemic control performance data

• New standardised Intravenous Insulin protocol for all patients undergoing cardiac surgery and guidelines for management of hyper and hypo-glycaemia