Optimising inpatient hypoglycaemia management: A closed-loop quality improvement project enhancing protocol adherence and patient safety among resident doctors in care of the elderly and acute medicine department at Colchester general hospital

Background: Inpatient hypoglycaemia is a high-risk medical emergency requiring rapid, standardized management. Adherence to Joint British Diabetes Societies (JBDS) guidelines is critical to prevent severe neuroglycopenia, acute confusion, falls, and extended hospital stays, particularly among frail elderly patients. Baseline evaluation at a large NHS trust identified significant knowledge gaps and protocol non-adherence among resident doctors across Care Of The Elderly (cote) and acute medicine wards.

Methods: A closed-loop Quality Improvement Project (QIP) was conducted across two cycles using Plan-Do-Study-Act (PDSA) methodology. Baseline knowledge was assessed in cycle 1 (n=30). Key targeted interventions included point-of-care cognitive aids (lanyard reference cards and ward flowchart posters), QR-coded digital guideline access on blood glucose meters, targeted 10-minute micro-teaching sessions during handovers, and appointing ward hypo champions. Interventions were evaluated in cycle 2 (n=32).

Results: In cycle 1 (n=30), the mean overall clinical knowledge score was 6.77/10. Critical deficits included: Only 40.0% correctly identifying the 10–15-minute re-testing interval (rule of 15), 23.3% recognizing the mandatory 40g long-acting carbohydrate recovery dose following glucagon administration, and 30.0% failing to identify <4.0 mmol/l as the treatment threshold. Following multi-modal intervention rollout, cycle 2 demonstrated marked clinical improvement: The mean knowledge score increased to 8.84/10 (median 9/10). Protocol threshold recognition reached 100.0% (32/32), 10–15-minute re-testing interval knowledge improved to 93.8% (30/32), post-glucagon recovery dosing awareness nearly tripled to 65.6% (21/32), and high-risk sulphonyl urea awareness increased to 84.4% (27/32).

Conclusion: Multi-modal educational interventions and point-of-care visual prompts successfully resolved critical knowledge deficits in inpatient hypoglycaemia management. Closing the audit loop demonstrated sustained alignment with JBDS national guidelines, mitigating recurrent hypoglycaemic events, improving patient safety, and establishing a scalable framework for trust-wide acute care quality improvement.

Hyder Khan is an internal medicine registrar at Colchester general hospital with the NHS. He has completed the MRCP in July 2026 and serves as an associate college tutor for the royal college of physicians. He also holds leadership roles as internal medicine trainee lead and acute medicine teaching lead. He graduated from Ras al-Khaimah Medical and Health Sciences University in 2019, completed internship with the UAE ministry of health, and worked as a general physician for two years before moving to the UK. In the UK, he began as an SHO at Basildon hospital in 2023 before joining the IMT program at Colchester in August 2024. He is now an internal medicine registrar in the final training year with a focus on diabetes and endocrinology.