Bridging Inpatient to Outpatient Diabetes Care

Innovations in Diabetes & Metabolic Care | Fall 2023

“So, tell me your story.”

Lucy Colo, MSN, RN, meets people with diabetes who are hospitalized at University Hospitals Cleveland Medical Center, she leads with connection. “I spend the first part of the visit listening,” says Colo. “It opens the door to understanding patients’ challenges and how they take in information.”

Colo is a member of the UH Diabetes and Metabolic Care Center’s multidisciplinary team of experts providing leading endocrinology and coordinated care services to support diabetes self-management. She provides insight into best practices for transitioning individuals from inpatient to outpatient care.

Build a Foundation

Whatever initially brings people to the hospital, many first discover their diabetes because of inpatient lab work.

“The diagnosis can be overwhelming,” says Colo. She has invested thought into what is most crucial for patients to know first, breaking information into digestible pieces so they can begin taking care of themselves. Patients’ initial worries may include:

• How do I check my blood sugar or give myself an injection?
• What does insulin do, and how does it need to be stored? 
• What changes do I need to make in my diet?

“I tell patients diabetes is a journey,” she says. “We focus on the hot-topic details so they feel comfortable with the basics before they leave the hospital.”

Develop a Plan for Follow-up

The UH Diabetes and Metabolic Care Center reserves clinic time to see patients within two weeks of leaving the hospital. “Access to care is a real challenge that we are working to address by having dedicated discharge clinic slots for folks,” says Colo. “Also, our providers do a great job connecting patients to diabetes services within their local community.”

They also ensure patients have a phone number to call for help. In addition to the call line provided on discharge papers, Colo offers patients a card with her contact information and makes time to reach out and check on their progress. “It is rewarding to hear patients have had that ah-ha moment and are doing well,” she says. 

Reinforce Self-Management Skills

Often, patients with diabetes are admitted to the hospital with a new health challenge. “Maybe they had a heart attack or a stroke, and they need a little reinforcement about how to better manage their blood sugar,” says Colo. “Life is hard with diabetes, and we are here to reassure patients about how manageable it can be.” 

As she works to increase medical literacy, Colo relies on visual learning, repetition and analogies. Two comparisons she finds effective are sports and strawberries. One analogy she learned from a diabetes educator colleague is to ask patients, “If there is no football score on the screen, how do you know who is winning?” she says. “People make the connection to understanding their glucose numbers when they are self-administering insulin.”

Colo also asks patients to picture a bowl of sugared strawberries. “When you return in 20 minutes, the berries are mushy and watery,” she says. “That is similar to what is happening in your body because the excess sugar is drawing fluid out of tissues, causing dehydration and thirst.”

Address Underlying Causes of Readmission

A challenge to diabetes care delivery is emergency department (ED) readmission. Often, social determinants of health impede an individual’s access to proper nutrition, medication or transportation to medical appointments. With limited options, patients turn to emergency care. 

Colo understands her patients’ frustration. “I don’t think anybody chooses to be in the hospital, but life happens — you can handle so much, and then you can’t,” she says. “We are fortunate to be able to make referrals to the Medicaid Community Clinical Case Management Program to identify resources for our patients who return to the ED frequently.” 

Another resource University Hospitals offers is access to a continuous glucose monitor (CGM). Providing 24-hour monitoring, the wearable device improves blood sugar tracking and reduces the need for finger sticks.

“As our discharge program has grown, we are able to introduce patients to CGMs before they leave the hospital,” says Colo. “Patients get to manipulate the device and practice with it, and it provides them with a greater sense of control.”

Collaborate with Pharmacy

The UH Diabetes and Metabolic Care Center has integrated specialized pharmacy services into its program. Its novel Meds to Beds program ensures patients have all necessary medications and equipment prior to discharge. Providers put in orders for diabetic supplies, and they are delivered bedside. 

“Our collaboration with pharmacy has been so successful,” says Colo. “The program reduces discharge delays and eliminates the need for patients to stop at an outside pharmacy on their way home.” 

Think Inside the Box

A specific challenge Colo saw was preparing patients to use insulin pens. She wrote a grant and received funding from the auxiliary of University Hospitals to create an insulin pen education kit. The boxed kit includes demo insulin pens and needles, a cushion to practice injections on and a laminated instruction card reprinted from the center’s diabetes handbook. 

Colo provided quick in-services to units throughout the hospital so that nurses can help patients practice when a clinical educator is unavailable. “The resource is on the floor to provide patients step-by-step instructions,” she says. “We are grateful to the auxiliary for providing funds to make the project possible.”

For more information, contact the UH Diabetes and Metabolic Care Center at 440-860-2353.

Contributing Expert:
Lucy Colo, MSN, RN
Clinical Educator
University Hospitals Diabetes and Metabolic Care Center
University Hospitals Cleveland Medical Center