DIABETIC​ FOOT DISEASE​

Emma Jay - Senior Clinical Podiatrist​
Department of Endocrinology & Diabetes, RBWH, MNHHS​

Transcript

1. DIABETIC FOOT DISEASE Emma Jay - Senior Clinical Podiatrist Department of Endocrinology & Diabetes, RBWH, MNHHS
2. About Me ◦ BSc (Hons) Podiatry Salford / Manchester, UK ◦ Graduate Job - Alexandra Hospital, Singapore ◦ Band 7 – St Helier Hospital, London NHS ◦ Learned German and worked in Private Practice, Munich ◦ Consulted to Diabetic Smart Insole MedTech Startup, New York ◦ Joined QLD Health in May 2020 Emma Jay Senior Clinical Podiatrist
3. This Talk ◦ Status of Diabetic Foot Disease in Australia ◦ Goals and Areas for Improvement ◦ Early Screening ◦ How to Refer to Podiatry
4. What’s all the Fuss? For Patients ◦ Missing pain sensation leads to serious underestimation of ulcer severity by patient and clinicians ◦ Patients with with Foot Ulcers have significantly lower Quality of Life scores ◦ Diabetic Foot Disease (DFD) is the leading cause of amputations in Australia ◦ Major amputations are a leading cause of hospitalisations and often result in death
5. What’s all the Fuss? Australia by Numbers ◦ 50,000 people living with Diabetic Foot Disease ◦ 12,500 people living with an amputation caused by diabetic complications ◦ 4,400 amputations in Australia (2016) ◦ 1,700+ people a year with DFD die as a direct result of foot ulcers and lower limb wounds ◦ $1.6 Billion in costs each year from Diabetic Foot Disease
6. What’s all the Fuss? How do we stack up? ◦ Australia has improved its diabetes-related amputation rate, climbing the ranks over the last decade to 9th place in 2017 ◦ NADC standards (2019) – Report In the UK, the amputation rate comparing across publications, is approximately half that of Australia’s urban dwelling people with diabetes
7. What’s all the Fuss? OEDC 2019 Report
8. What's Possible? Forecasted between 2018-2022 ◦ Diabetic Foot Australia published 2017 forecast ◦ By implementing evidence based care throughout Australia ◦ 11,000 hospitalisations a year could be prevented ◦ $550 million dollar saved a year
9. What's Possible? Close the Gap ◦ UK Stats demostrate potential for nearly 2x improvement of current Australian numbers ◦ Set ourselves ambitous goal of closing the gap and catching up with the UK ◦ Bring RBWH + QLD Health ulcer healing rates up and amputation rates down
10. How do we get there? Timely Referrals ◦ (NDFA 2019) Ulcers undergoing expert assessment within 2 weeks are less likely to be severe and more likely to heal by 12 weeks ◦ Undiagnosed foot ulcers missed during a hospital stay will miss the 2 week window ◦ RBWH access to specialist care
11. How do we get there? Clear Communication ◦ Be explicit in the referral about what you need ◦ If in doubt contact us ◦ Regular foot checks – our eyes and ears on the wards
12. The Importance of MDTs ◦ A study from the UK showed major amputations fell by 62% over 11 years using an MDT approach Key Specialties ◦ Podiatry – Coordinators / Specialist of Diabetic Foot Disease ◦ Vascular – Revascularisation – NADF found highest risk factor for non healing ◦ Orthopaedics – Recorrective surgery / Amputations, Charcot ◦ Infectious diseases – Osteomyelitlis ◦ Endocrinology / Diabetic Nurse Educators – HbA1c ◦ Prosthetic and Orthotics – Offloading ◦ Physiotherapy – Falls prevention
13. How patients end up in Podiatry? Potential Pathways ◦ Internally via ED triaged to: ◦ Vascular ◦ General Medicine ◦ Orthopaedics ◦ Renal / Dialysis ◦ ICU ◦ Externally through: ◦ GPs ◦ Private Podiatry
14. How to spot a problem
15. Long / Thick / Ingrown Nails
16. Blisters / Fissures
17. Callous
18. Ulcers
19. Infection
20. Necrosis
21. Charcot Foot
22. Our Methodology - MADADORE ◦ Metabolic / Medication ◦ Assessment ◦ Debridement ◦ Antibiotics ◦ Dressings ◦ Offloading ◦ Referral ◦ Education
23. Where do our Patients go? Depending on Wound Severity ◦ Stay in the Specialist Outpatient Department of RBWH ◦ Transfer to Metro North Community Centres ◦ Chermside ◦ Caboolture Community and Oral Health ◦ North Lakes Health Precinct ◦ Zillmere ◦ Brighton ◦ Telehealth ◦ Other Health and Hospital Services
24. How to Refer ◦ Fill out Internal referral form and fax it ◦ Please ensure referrals are specific ◦ Especially for out of hour referrals ◦ Think about end of the week – possible d/c over the weekend Fax 📠 67212 Gomathi 📟 42769 Emma ☎️ 71022 Podiatry Contacts
25. Patients without Wounds ◦ Add Enhanced Primary Care Plan to Discharge Letter ◦ Ensure Patients are using the EPC after Discharge ◦ Private Practice can flag DFUs ensuring expert assessment within 2 week window
26. #1 Take Away from this Talk ◦ Catching and treating ulcers within the 2 week window means vastly better downstream outcomes ◦ Frequent & early foot checks can prevent readmission for acute wounds and stop chronic life long foot disease ◦ Someone has to check. A few seconds can literally save a life!
27. Questions? Please share this slide deck with your colleagues! ◦ Get the word out and pass it on ◦ Invite me to give this talk to another group bit.ly / 2U9WXep Fax 📠 67212 Gomathi 📟 42769 Emma ☎️ 71022 Podiatry Contacts Slide PDF