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Integrated care for the diabetic foot: impact on outcomes

Integrated care for the diabetic foot: impact on outcomes. Gerry Rayman Ipswich Hospital Suffolk. The Ipswich Diabetic Foot Clinic. Untreated Infection. Replace footwear. Lose footwear. Off-loading. Off-loading and treatment of infection. Healing. Amputation. Referred to Foot Clinic.

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Integrated care for the diabetic foot: impact on outcomes

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  1. Integrated care for the diabetic foot: impact on outcomes Gerry Rayman Ipswich Hospital Suffolk The Ipswich Diabetic Foot Clinic

  2. Untreated Infection Replace footwear Lose footwear Off-loading Off-loading and treatment of infection Healing Amputation Referred to Foot Clinic Wound

  3. Screening to characterise risk Pathways Health care professional Patients and carers Coordination of Interventional procedures

  4. Ipswich Diabetic Foot Unit Main Treatment Room

  5. Primary Care GPs Practice nurses Community nurses Podiatrists Patient held record ‘Hot Line’ DSN Senior Podiatrist Secondary Care Diabetologist Podiatrist Orthotist Vascular & Orthopaedic surgeons Radiologist Community nurse Community Podiatrist

  6. Integrated care

  7. Fast tracking

  8. Possible admission routes for the acute diabetic foot There needs to be a clear pathway for the acute diabetic foot

  9. Amputation rates 1995-2009 per 100,000 gen population 2.82 Amputation rates per 100,000 gen. population

  10. UK Evidence for effectiveness of Multi-disciplinary foot teams and provision of inpatient foot care service

  11. Larsson J, Eneroth M, Apelqvist J, Stenstrom A. Acta Orthop 2008

  12. The trend of Total amputations in diabetes in Finland Number of 1st Amputations per 10,000diabetics in Finland 1988-2002 Lepantalo 2006

  13. Total Amputations (major and minor) per 10,000 diabetics

  14. Trends in LEA in people with diabetes in England 1996-2005 (HES data) Type 1 Minor decreased 11.4% Major decreased 41.0% Type 2 Minor increased 95.0% Major increased 83.5% Vamos EP; EASD 2009

  15. Why is care patchy across the UK?

  16. Not rocket science Not on the agenda

  17. PCTs SHAs Trust CXs commissioners

  18. Loss of in patient foot nurse Foot protection team not supported in primary care Community podiatry not full integrated Education of community staff relies on good will- no funding Not all plain sailing

  19. Southampton 2003 -2007 (520 admissions) LOS from 50 days to 18.5 days Major amputations reduced by 60%

  20. Patient safety ££££££

  21. Bed days –Invest to Save Saving ~£400,000

  22. “I marvel that society would pay a surgeon a large sum to remove a patient’s leg but nothing to save it”. George Bernard Shaw

  23. “I marvel that the health service should continue wasting large sums on the disasters arising from poor diabetic foot care but little or none to develop integrate services to prevent them in the first place” Gerry Rayman

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