FP02-2 Realtime 24/7/365 Management of Pediatric Diabetes By Novel Utilization of Pedi-Flite, a Hospital-Based Transport Team

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: FP02-Obesity and Diabetes: Drugs & Interventions
Saturday, June 15, 2013: 11:00 AM-11:30 AM
Presentation Start Time: 11:05 AM
Room 303 (Moscone Center)

Poster Board SAT-789
Brandi E Franklin*1, S. Crile Crisler Jr.2, Rebekah Shappley1, Meri M. Armour2, Dana T. McCommon2 and Robert J Ferry Jr.3
1University of Tennessee Health Science Center, Memphis, TN, 2Le Bonheur Children's Hospital, Memphis, TN, 3University of Tennessee, Memphis, TN
Background: Increasing demands overwhelm pediatric endocrine workforces in every jurisdiction (1). Rising incidences of both diabetic ketoacidosis (DKA) and recently diagnosed type 1 diabetes (T1D) underscore the urgency to expand an effective workforce (2-4). To improve access for underserved diabetic patients, we hypothesized that novel integration of our hospital-based, pediatric transport team with Pediatric Endocrine Center operations could significantly improve access, promote continuity of care from pre- hospital to in-patient settings, and sustain diabetes self-management.

Objectives: Improve access to care via novel integration of Pedi-Flite (transport team for our tertiary care hospital) and validate whether this novel approach: a) safely enhances diabetes care; b) effectively expands endocrine workforce; c) is accepted by patients; and d) builds community resources for care.

Design: Prospective cohort study comparing periods prior to and after inception (2008) of Pedi-Flite support. Pedi-Flite and endocrine directors designed 6 laptop-based protocols for managing calls to a pager dedicated to diabetic patients. Pedi-Flite staffs ≈40 personnel with national certification at least EMT-IV. Our ADA-certified diabetes educator and endocrine medical director trained Pedi-Flite staff, with refresher training upon request for new staff. All diabetic patients with care established under UTHSC pediatric endocrine faculty were included. Calls were digitally recorded for quality assurance.

Data: Pedi-Flite serviced 1,219 calls from 373 families. Protocols used were Patient Feels Sick (n=105), Equipment Malfunction (n=5), Wrong Insulin Dose (n=21), Blood Sugar is “X” (n=690), Needs Prescription Refill (n=86), and Other (n=312). After advising families per protocol, Pedi-Flite referred 36 cases to follow-up in endocrine clinic within 24 h. After assessment per protocol, Pedi-Flite communicated 398 cases realtime to the endocrine provider on call and directly referred 117 cases to the closest emergency department. Families and staff alike accepted this system well. There were no increased costs for Pedi-Flite manhours for pager staffing. Primary communication failure events were rare (8 pager replacements), with comparably low complaints from participants. All communication failures were promptly resolved by families contacting the usual call center (after hours) or clinic (regular business hours). Ongoing work will identify variables predicting optimal use of this system.

Conclusion: Integration of a hospital transport service provides a novel, cost-effective approach to reduce disparities in diabetes care. Advantages include its scalability (by adding new protocols or staff), professional development for participating EMTs with increased knowledge and confidence, and low added costs.

(1) Lee JM et al. J Pediatr 2008;152:331-6. (2) Nyenwe E et al. Metabolism 2007;56:172-8. (3) American Diabetes Association. Diab Care 2012;35:S11-S63. (4) Dunger DB et al. Pediatrics 2004;113:e133-40.

Disclosure: RJF Jr.: Study Investigator, Eli Lilly & Company, Study Investigator, Bristol-Myers Squibb, Study Investigator, Takeda, Study Investigator, MacroGenics, Study Investigator, Pfizer, Inc., Study Investigator, Novo Nordisk, Study Investigator, Tolerx, Study Investigator, Ipsen. Nothing to Disclose: BEF, SCC Jr., RS, MMA, DTM

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: Le Bonheur Foundation (Memphis TN)