Implementing a multi-centre hypoglycaemia management surveillance model through a co-designed approach to develop actionable insights in the UK.

Introduction: Severe hypoglycaemia is associated with increased mortality. While considered a never event, severe hypoglycaemias continue occurring in people admitted to hospital. Inconsistent data collection and surveillance limits our ability to assess trends, identify risk factors and implement targeted interventions. This study aimed to (1) co-design a multicentre audit model for inpatient hypoglycaemia (2), evaluate its acceptability and feasibility and (3) analyse hypoglycaemia management to inform quality improvement initiatives. Methods: A hypoglycaemia audit system was co-designed with diabetes specialists, resident doctors and medical students, guided by ERIC study recommendations and the CFIR framework. Piloted at one site, it then expanded to ten hospitals, where feasibility and acceptability were evaluated using stakeholder feedback and system performance. The model was delivered via Plan-Do-Study-Act cycles and train-the-trainer methods. Data on demographics, precipitants, treatments, and outcomes of clinically significant hypoglycaemias in people with diabetes were analysed to identify risk factors and adherence to guidelines. End-user and expert feedback informed system validation. Results: The system was refined via stakeholder input and Plan-Do-Study-Act cycles to ensure usability before expanding to ten hospitals, where it achieved high acceptability. Over 11 months, 1,451 severe hypoglycaemias in 945 patients were recorded. Common precipitants included illness and missed meals. Management varied significantly between hospitals, e.g., glucagon use ranged from 2.6% (Hospital C) to 38.7% (Hospital E). Two hospitals within the same NHS trust showed differences in hypoglycaemia severity, treatment choices and mortality despite similar patient demographics. Conclusions: The co-designed multicentre digital evaluation model for in-hospital hypoglycaemia was successfully implemented with high acceptability and feasibility. Key findings highlight gaps in management, including suboptimal treatment adherence and high recurrence rates. Addressing these issues through real-time monitoring, targeted interventions and improved guideline adherence could enhance patient outcomes. This standardised model could address differences in healthcare regionally and nationally for other conditions.