Over a 3 year period (2012-2015) the number of patients admitted to St. Vincent’s University Hospital for the management of the acute diabetic foot increased by 52%.
Patients had an average length of stay of 26 days and a readmission rate of 43% within 2 weeks of discharge. There was also a 20% increase in the number of lower limb amputations performed.
The Acute Diabetic Foot Pathway is a multidisciplinary approach that improves patient care in St. Vincent’s University Hospital.
The project won the Best Integration award at the 2017 Health Service Excellence Awards.
A multidisciplinary task force was established to audit the service and identify any areas for improvement. Inpatient and theatre data over a 12 month period was retrospectively analysed. The task force identified five key areas which were:
- Reduce patient length of stay (LOS)
- Streamline and improve patient care
- Improve patient outcomes
- Improve access to diagnostics and interventions
- Ensure multidisciplinary approach to patient care
The task force reviewed the current national guidelines (Model of Care for the Diabetic Foot, HSE, 2011) and international best practice guidelines to establish a quality improvement plan. From this plan, the Acute Diabetic Foot Pathway booklet was developed.
To successfully implement this project, task force and all the members of the multidisciplinary team were committed to improving patient care and outcomes based on best practice guidelines. This involved nurses, doctors, podiatry, allied health and non-clinical departments (such as bed management, clinical audit).
The entire team was committed to providing high quality care Learning. Team members gained experience in developing a care pathway, performing audits and maintaining KPIs. All members were up to date on the best practice in the management of these patients. The development implementation of the pathway was a valuable learning experience for all involved.
This project has had a huge impact on patient satisfaction and outcomes. Length of stay is greatly reduced and patients are now treated at home if OPAT is available in their area. There are less major limb amputations performed and less readmissions. Anecdotally some patients have re-engaged with their local diabetic services. From an organization's perspective there was a dramatic reduction in length of stay, less readmissions within 2 weeks of discharge and a substantial cost saving.