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Over the last 15 years the diabetic population served by Salford Community health has doubled from 5,000 in 1995 to 10,000 in 2010. The care pathway for people with diabetes was complex, with one service based in the community and one in the hospital. Amputation rates were above average at 24 per 100,00 population.
The aim of the project was to reorganise and streamline the foot care pathway for people with diabetes and for community and secondary care to act as one service rather than two.
What did they do?
Changes to the service began in 1995 when a Diabetic Foot Steering group was established and a high risk liaison podiatrist was appointed to work across both community and secondary care. The steering group comprised a consultant diabetologist, the high risk liaison podiatrist (who led the project), the community and acute podiatry managers and an audit project worker. The district nursing team was also involved.
The team agreed on three pre-requisites for the project success:
- A redesigned foot care pathway the new pathway was designed using an escalator approach so that patients are able to move smoothly and quickly through community to acute and back to community care according to their clinical condition.
- A paper based patient record this was carried by the patient and presented to the podiatry services at appointments. The record of the attendances were filled out in triplicate, one for the patient record, one for the clinical notes and the third was sent for auditing purposes. The record is now electronically based.
- A reorganised case load for the podiatry services patients who were clinically stable were transferred from the acute to the community service, freeing up places for patients requiring more acute care. Patients attending the community podiatry service were reviewed and discharged as appropriate.
The service now offers patients daily foot care clinics, along with specialist services such as at-home IV antibiotic therapy, in conjunction with the IV therapy team and microbiology; orthotics and foot wear; preventative foot care for those at medium and high risk of ulcers; access to vascular and orthopaedic surgeons.
The team run educational events for community and primary care stuff and podiatrists visit hospital wards to raise awareness of the foot care service. Email alerts are sent to wards when patients known to be at risk of foot ulcers are admitted.
Over the course of the project, the rate of amputations per 100,000 population has fallen from 24 to 8. The number of foot ulcers has fallen from 900 in 2006 to 600 in 2010. This suggests a potential saving of over £1m (assuming a cost per ulcer £3,500).
- Amputation rates have fallen by two thirds.
- Number of foot ulcers has reduced by 300 over four years.
- Estimated savings of over £1m over four years.
These appendices are supplied by the trust from which the success story originates. If you use content from the documents, please ensure you appropriately reference them in the normal style used by your publication/organisation.