Primary care referral to multidisciplinary high risk foot services - too few, too late.

D Plusch,M Malone,HG Dickson,S Penkala

doi:10.1186/s13047-015-0120-7

D Plusch, M Malone + Show 2 more

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https://doi.org/10.1186/s13047-015-0120-7

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Abstract

BackgroundTo determine if patients with no contact with a multi-disciplinary team High Risk Foot Service (MDT-HRFS) had an increased rate of hospital admission for diabetes foot infection compared to patients with contact. Secondary aims were to report on clinical outcomes.MethodsA retrospective study was conducted at a major tertiary referral hospital in metropolitan Sydney over 12 months. An ICD-10 search of the electronic medical record system and paper medical charts identified patients with diabetes mellitus (type 1 or type 2) and a primary admission for diabetes foot infection (DFI). Patients were categorised as having contact or no contact with an MDT-HRFS.ResultsOne hundred ninety-six hospital admissions (156 patients) were identified with DFI over a 12-month period. Patients with no contact with a MDT-HRFS represented three quarters of admissions (no contact = 116, 74.7 % vs. contact = 40, 25.6 %, p = 0.0001) and presented with more severe infection (no contact = 39 vs. contact = 12). The odds of lower extremity amputation increased five-fold when both no contact and severe infection occurred in combination (no contact with severe infection and amputation = 34, 82.9 % vs. contact with severe infection and amputation = 7, 17.1 %, OR 4.9, 95 % CI 1.1–21.4, p = 0.037). Using estimates of both the contact and no contact population of people with diabetes and high-risk feet and assuming the risk of amputation was the same, than the number of expected amputations in the no contact group should have been 55, however the observed number was 77, 22 more than expected (p = 0.0001).ConclusionsPatients with no contact with a MDT-HRFS represented the majority of admissions for DFIs to a tertiary referral hospital. This group on population estimates appears to be at high risk of amputation of the lower extremity and therefore early referral of this high-risk group might lower this risk.

Highlights

To determine if patients with no contact with a multi-disciplinary team High Risk Foot Service (MDT-HRFS) had an increased rate of hospital admission for diabetes foot infection compared to patients with contact
Most frequently diabetes foot infection (DFI) are preceded by ulceration, where a break in the protective barrier of the skin leaves a portal of entry for invading pathogenic organisms
Emergency referral to a MDT-HRFS within 24 h is recommended when there is a new ulcer, swelling or foot discolouration [8]

Summary

Introduction

To determine if patients with no contact with a multi-disciplinary team High Risk Foot Service (MDT-HRFS) had an increased rate of hospital admission for diabetes foot infection compared to patients with contact. Foot infections are one of the most common causes of hospitalisation in people with diabetes [1, 2] with up to 85 % of cases proceeding to a diabetes related lower extremity amputation [3]. Primary care practitioners while providing the majority of medical care for people with diabetes, play an important role in routine screening, identifying the risk of diabetes related foot pathology and referral needs [5]. Clinical guidelines recommend primary referral of people with a high risk foot to a MDT-HRFS with specialist care from medical, surgical, nursing, podiatry and allied health professionals [5, 7, 8]

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