Building a scalable diabetic limb preservation program: four steps to success

Abstract

Over the past generation, limb preservation programs and diabetic foot services have begun to proliferate within academic health science centers as well as within health-care systems in general. We describe four key components for a successful program that, developed sequentially with temporal overlap, can allow the program to scale. The first component includes establishment of a ‘hot foot line’ for urgent emergency department/inpatient referral. The second includes development of a wound-healing clinic to address outpatient care through to remission. The third component focuses on the diabetic foot in remission to maximize ulcer-free days following healing. The fourth and final component focuses on implementation of local and widespread screening clinics to identify and triage patients into appropriate therapeutic and surveillance programs for healing, remission, and primary prevention. Along with developing each of these components, we describe discrete methods to quantify success.

‘CPR for Feet’ care bundle to improve foot assessment in inpatient diabetes

“…Indeed, recent work in the USA has provided guidance for the management of diabetes foot complications as well as recommending steps to implementation of successful programme for limb preservation. 9 10 Core components of this include establishing a pathway for urgent referrals, readmission alerts for known ‘at risk’ patients and careful discharge planning of those identified as having diabetic foot complications.…”

The use of recombinant epidermal growth factor in primary health assistance

“…An evaluation of amputation risk was performed in each patient as recommended Khan and others. [15][16] Al comorbidities were evaluated by a multidisciplinary team like appears in some bibliographies. [17][18][19] In our opinion the extension of diabetic foot treatment to primary health care is highly satisfactory if the personnel is previously educated and checked closely.…”

A call for integrated foot care and amputation prevention pathways for patients with diabetes and peripheral arterial disease across Canada

“…However, anyone involved in foot care in Ontario can attest to the fact that patients frequently fail to navigate the disjointed services necessary to prevent limb loss. In the United States and Europe, limb preservation programs and accredited specialty centres consistently achieve inspiring results (Neville and Kayssi 2017;Khan et al 2018;Morbach et al 2016). Their success is underpinned by prompt evaluation, multidisciplinary expertise, and dedicated resources.…”

“…Integrated trauma systems for severely injured patients and regionalization of cancer care have, however, helped overcome geographic barriers to care and save lives (MacKenzie et al 2006;Canadian Partnership Against Cancer 2015). With respect to amputation prevention, multidisciplinary evaluation and intervention for complex wounds and arterial insufficiency could be directed towards dedicated centres of excellence, ideally modeled on limb preservation centres in the US and Europe (Neville and Kayssi 2017;Khan et al 2018;Morbach et al 2016). However, screening in primary care and outpatient foot care are as, if not more, important than acute care of foot complications.…”