Coordinating care in acute diabetes foot problems: no mean feet!

Abstract

A multidisciplinary foot care team exists to coordinate specialist care for people with complex diabetes-related foot problems. The local multidisciplinary diabetes foot care team (MDFT) consists of a diabetes specialist, diabetes specialist nurse, orthopaedic surgeon, a visiting vascular surgeon and a podiatrist. Concerns around inpatient care were raised following a man who presented with a foot attack who underwent major limb amputation and subsequently died. A root cause analysis and Serious Untoward Incident panel identified reasons for delays in good clinical care. Undue emphasis on the need for further imaging, lack of urgency to surgically debride and request for other specialty assessments contributed to the delay in providing potentially life-saving treatment. Specialist ownership of patients with multidisciplinary input and lack of a clear management pathway also contributed. The Guildford Footpath is a clinical decision tool for acute diabetes foot problems developed by physicians and surgeons working together. It is a practical and safe way of helping non-specialists to assess patients presenting with acute diabetes foot problems. It clearly assigns responsibilities amongst specialist teams and provides a route for each specialist team to access members of the MDFT in a timely manner. It has streamlined care and given those involved more confidence in making decisions. We hope that ongoing audit will show a reduction in length of stay and amputation rates.