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  5. Providing a Diabetes Foot Care service at George Eliot Hospital (current)

Providing a Diabetes Foot Care service at George Eliot Hospital

The Multi-Disciplinary Foot Team (MDFT) have been commissioned and launched in March 2021 at George Eliot Hospital (GEH) for Warwickshire North patients with diabetes foot problems to be referred by Primary and Community Care who have urgent and complex active foot problems at extreme risk of amputation or loss of life. This team provide Diabetes Foot Care service in outpatient setting at GEH with active collaboration between acute and the community setting. 

 

Why change was needed

NICE Guideline 19 (2015) supported the set up of MDFTs in hospitals to reduce amputations, hospital admissions and care variations. Due to GEH not having an MDFT, the numbers of referrals to UHCW far outweighed its capacity putting a burden on the wider health economy. During the past 5 years it has taken a tenacious effort to set up a MDFT at GEH. In 2016, it was recognised that local minor and major amputation rates were increasing in North Warwickshire area. 

 

What we did

An integrated Diabetes foot care pathway was designed and agreed across all healthcare settings, primary through to tertiary care. All Diabetes foot referrals are triaged through the single point of access in SWFT Podiatry. Complex Active Foot problems such as osteomyelitis, infected foot ulcers and Charcot are fast tracked to either MDFT at GEH and/or to Community Podiatry with the aim of reducing time to first expert assessment. Currently 67% of diabetes foot referrals are from Primary care, any urgent referrals are expected to be fast tracked into the service. Community Podiatry share the care of these complex patients with the MDFT and continue ongoing care once discharged from MDFT.

The GEH MDFT clinical team comprises of Diabetes consultant (Lead-GEH), Podiatrists (SWFT), Orthotist (GEH-Private SLA), Diabetes Specialist Nurse (SWFT), Vascular Surgeon (UHCW), Orthopaedic Surgeon (GEH) and HCA (GEH). The MDFT clinic acts as a one stop clinic for patients to see all appropriate professions which reduces delays, improves communication and optimises care.

In evaluation in March 2022, in the previous 9 months 85 patients were referred. Currently 18% of all patients with osteomyelitis have healed and 10% of foot ulcer patients. 29% of ulcers are no longer complex wounds (i.e. not to bone or tendon) therefore have been discharged back to community Podiatry management. These can easily be escalated back to the clinic if the healing trajectory slows. The cross organisational relationships between the team members are working very well. This ultimately improves the outcomes for patients by having a connected team approach. 

A recent patient with suspected Charcot was so grateful for the care he received when he was sent from Podiatry to the Orthotist and fitted with a complex offloading boot within 24hrs, and said he was “extremely happy with the service” and stated that it was “the first time that he felt supported and listened to”.

 

What's next?

The project is continuing to run business as usual.