Diabetes Out of Hospital (OOH) Service at SALHN

The SALHN Out of Hospital (OOH) Diabetes Service consists of Diabetes Nurse Educators and Diabetes Dietitian led services working in collaboration with Endocrinologists.

The service has established referral pathways to other allied health providers to ensure the provision of holistically based diabetes services for people over the age of 16 years with diabetes, excluding pregnancy.

The objective of the OOH Diabetes Service is to enable patients to self-manage their diabetes throughout their life span. The service collaborates with the patient to support hospital avoidance, provide supported discharge from hospital and prevent diabetes related complications.

Eligibility criteria

  • Newly diagnosed Type 2 diabetes in adults
  • Pre-existing Type 2 diabetes in adults with HbA1c >8%
  • Type 2 diabetes in adolescents > 16 years and young adults
  • Newly diagnosed Type 1 Diabetes
  • Pre-existing Type 1 diabetes in adolescents >16 years or adults
  • Newly diagnosed or existing Type 3c diabetes
  • Severe or recurrent hypoglycaemia or DKA
  • Micro or macrovascular complications or relevant comorbidity
  • Requirement to commence insulin
  • Aboriginal or Torres Strait Islander with Type 1 or Type 2 diabetes
  • Medically diagnosed mental illness and Type 1 or Type 2 diabetes

Exclusion criteria

  • Paediatrics <16 years
  • Pregnancy
  • Management of people without diabetes
  • Management of people with Type 2 Diabetes HbA1c <8% (refer to exceptions below)
  • Alternative Diabetes Nurse Educator or Dietician Services already in place
  • Clients not living with the SALHN catchment area

Exceptions to exclusion criteria includes management of people with Type 2 Diabetes (HbA1c <8%) for vulnerable groups, Aboriginal and Torres Strait Islander people and people with a diagnosed mental health condition, people aged 16-30 years.

Appointments are offered based on each individual’s needs including: groups, home or clinic visits or telehealth appointments.

The OOH Diabetes Service staff are specialists in the area of pump therapy, medical nutrition therapy including advanced carbohydrate counting, insulin titration, Continuous Glucose Monitoring, management of complex needs and can offer expert advice to other health professionals. 


Referral information

For referrals to be actioned, referrals must include:

  • type of diabetes
  • reason for referral
  • details of referral
  • recent pathology including HbA1c

For newly diagnosed Type 2 Diabetes, diagnostic pathology to be included

Referrals that do not contain the above mandatory fields will not be action and you will be informed via letter of this decision.

Please ensure patients meet the referral criteria. Forms to be saved and integrated into relevant GP Practice systems. See fact sheet for further instructions on how to integrate.

Diabetes Out of Hospital Referral Form (PDF 173KB)

Templates for GP systems

SALHN Diabetes Out of Hospital Referral Form - Medical Director (RTF 94KB)
SALHN Diabetes Out of Hospital Referral Form - Best Practice (RTF 130KB)

Fact Sheets

Importing templates into Medical Director - fact sheet (PDF 55KB)
Importing templates into Best Practice - fact sheet (PDF 55KB)

Contact details

Telephone: (08) 8164 9111 (option 1)
Fax: (08) 8164 9199

Related services

SALHN Diabetes Services

Please note : this page is under review but Out Of Hospital Diabetes Service (formerly Intermediate Care Services) links are appropriate.