How to Set Up a Multidisciplinary Foot Team (MDFT) for Patients with Diabetic Foot Ulcers?

Abstract

Introduction - We would like to share our experience of setting up an MDFT for patients with diabetic foot ulcers according to NICE guidelines and present early results. Methods - NICE guidelines indicate that every centre that treats patients with Diabetic foot ulcers should have an MDFT that is based in the hospital. The MDFT should be led by a hospital-based specialist diabetic podiatrist and should comprise of a diabetic physician, vascular surgeon, orthopaedic surgeon with special interest in foot and ankle surgery, diabetic nurse, vascular nurse, tissue viability nurse and Orthotic specialist. There should be close contact with the community podiatry for a seamless pathway for patients with diabetic foot ulcers in primary and secondary care. The main aims of the Diabetic MDFT are to reduce major amputations, reduce hospital stay and reduce readmissions. Screening patients for diabetic foot problems and education of patients and healthcare professionals are secondary aims of the MDFT. A diabetic foot ulcer MDFT has been operational at Bedford Hospital since August 2017. This comprises of a weekly diabetic foot round where inpatients and outpatients are discussed. We were successful in securing the National Diabetes Treatment and Care – Transformation Funding bid to help set up the MDFT. We encountered several hurdles in setting up the MDFT, which included dialogue and collaboration between finance officers and clinicians from primary and secondary care and between various hospital departments as well. The hub and spoke model of vascular services adds to the complexity of this venture. We have struggled with Orthopaedic input in the MDFT and organization of podiatry services in hospital. We present some strategies in overcoming these obstacles and recount our experience of setting up the MDFT. Results - A diabetic foot resister was started in August 2017 and so far >100 patients have been entered in this register. 79 patient episodes have been discussed in the MDFT involving 66 patients. We have had 48 new emergency referrals from the community and of these 30 have been triaged as needing an urgent podiatry appointment. This has been achieved on an average in 1.8 days. We have established an emergency hotline number to the diabetic podiatry clinic in hospital. Revamping of the ‘Hospital at Home’ team has been a tremendous support to the MDFT. We have reinforced links with community podiatry and MDFTs in other spoke hospitals in the Bedfordshire – Milton Keynes (BMK) Vascular Unit. Early results indicate a marked reduction in hospital admissions and hospital stay due diabetic foot problems. There have been only 3 major amputations since September 2017. Conclusion - It has been a huge struggle to set up the Diabetic MDFT at the BMK vascular unit, but early results indicate considerable benefits in terms of patient outcomes and costs. References - https://www.nice.org.uk/guidance/ng19