742. Identification of Barriers to Shifting Management of Diabetic Foot Infections from the Hospital Setting to a Multidisciplinary Wound Clinic

Abstract

Abstract Background Hospitalized patients with diabetic foot infections (DFI) are commonly stable upon admission and lack signs of sepsis, necrotizing fasciitis, critical limb ischemia, or bacteremia. Patients are admitted for key components of DFI care: non-urgent procedures for source control; radiographic imaging; cultures; consultation with infectious diseases (ID), podiatry, or vascular surgery; and peripherally inserted central catheter (PICC) access. We aimed to identify the proportion of patients with low acuity DFI who were hospitalized and to characterize potential barriers to outpatient management. Methods Between 2020 and 2021, data from the medical record were abstracted for adult patients admitted to Michigan Medicine with an ICD-10 admission diagnosis of DFI. Patients were categorized into low and high acuity cohorts. High acuity was defined as sepsis, necrotizing fasciitis, critical limb ischemia, or bacteremia. Low acuity was defined as clinical stability (≤ 1 systemic inflammatory response syndrome (SIRS) criteria) and without high acuity criteria. The primary outcome was the prevalence of low acuity DFIs admitted to the hospital, duration of hospitalization, and associated costs. Secondary outcomes included 30-day all-cause mortality, DFI recurrence, DFI readmission, and time from clinical stability to completion of DFI care (non-urgent procedures; radiographic imaging; cultures; consultation to ID, podiatry, or vascular surgery; and PICC access). Results Of 64 hospitalized DFI patients, 37 (58%) were low acuity and 27 (42%) high acuity. All low acuity patients were clinically stable on admission with a median hospitalization length of 6.3 days. Figure 1 shows the time to completion of key components of DFI care from clinical stability. Low acuity group had DFI recurrence of 5.4%; readmission with DFI of 10.8%; and all-cause mortality of 5.4%. The median hospitalization cost for low-acuity DFI was $55,500 per patient. Conclusion More than half of hospitalized DFI patients are low acuity, and could have avoided hospitalization. These patients had a median hospitalization length of 6.3 days and total cost of $55,500. Developing a coordinated process to manage low acuity patients outpatient may avoid unnecessary hospitalizations and reduce healthcare cost. Disclosures All Authors: No reported disclosures.