Download: Summary Success Story (PDF 276KB) / Full Success Story (PDF 104KB)

The challenge:

There are 14,000 people with diabetes served by the South Devon Healthcare Foundation Trust (FT). In 2005 major amputations (amputations above the ankle) in people with diabetes had risen to 36 a year, despite ongoing efforts to better manage foot care.

Aims:

The aim of the project was to bring together community and hospital foot care services and create a multi disciplinary team that accepted referrals from patients as well as healthcare professionals, and to monitor the impact of this change on amputation and bed occupancy rates.

What did they do?

The diabetes service at South Devon FT was already proactive and open to change. It was part of the UKPDS which had involved rotating GPs into the service as clinical assistants and it runs a liaison group for GPs, practice and district nurses. Additionally it has strong links with the local Diabetes UK branch.

To implement the changes needed in foot care, a project team was set up in 2006, led by the consultant diabetologist and including the lead hospital and community podiatrists. The first task was to set up open access outpatient clinics, which accepted referrals from any source, by telephone, email or fax. Referrals are responded to within 24 hours. The new service took about a year to plan, and during this time the outpatient facility was also refurbished.

Shortly after the new outpatient service was established, a review of the community services concluded that more administrative support was required to allow the community podiatrists to better carry out their clinical duties. The PCT agreed to fund six new part-time admin posts. This additional support has allowed community podiatrists to be rotated into the outpatient service for 3 months at a time. This provides the outpatient clinic with valuable extra support and allows the community podiatrist to update their skills and training

What changed?

As a result of the new service, major amputations have fallen from 36 a year in 2006 to 14 in 2009, and 4 during the first half of 2010.

Bed occupancy rates also fell, with the average number of patients going from 6-7 a week in 2006 to 3-4 a week once the clinic was set up. 75 percent of admissions are for planned surgery.

Key Outcomes

Appendices

• Appendix A - Audit of Minor Amputations 2000-2009 (PDF 1MB)

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.