Reducing length of stay for diabetic foot osteomyelitis patients

Abstract

Admissions for diabetic foot osteomyelitis (DFO) are associated with increased length of stay due to several modifiable barriers and one of which includes setting up intravenous (IV) antibiotics upon discharge. The aim of this study was to reduce the length of stay (LOS) by at least 10% for all DFO patients who underwent surgical amputation and required IV antibiotics upon discharge. Using a quality improvement approach, the patient journey was mapped out using Lean principles and areas of waste were identified. An innovative electronic order was created and implemented to facilitate placement of a PICC (peripherally inserted central catheter) line to be placed immediately after podiatry surgery to reduce the length of time between surgery and PICC line placement. Pre-intervention and post-intervention LOS was compared using Mann-Whitney test to analyze the nonparametric distribution of the data. The post-intervention group had a mean LOS of 7 days (pre-intervention group: 10 days, p-value=0.027), and the length of time between podiatry surgery to placement of the PICC line was a mean of 2 days (pre-intervention: 5.29 days; p-value=0.008). This study used Lean methodology to identify areas of waste, facilitate discharge and subsequently reduce the LOS for DFO surgical patients.

Gambaran Kejadian Kasus Osteomielitis Di Bagian Bedah Ortopedi RSUP Dr. M. Djamil Kota Padang Tahun 2018-2020

“…Rentang hasil penelitian ini sesuai dengan penelitian pasien dengan kaki osteomielitis diabetik (DFO/Diabetic Foot Osteomyelitis) diperoleh waktu rawat inap rata-rata adalah 10 hari. 34 Penelitian lain yang dilakukan Eric dkk. pada pasien dengan osteomielitis diabetik yang meliputi 2038 pasien diperoleh rata-rata lama rawat inap adalah 9,59 hari.…”

“…35 Pasien dengan DFO sering memerlukan rawat inap untuk debridement tulang yang terinfeksi dan kadang-kadang proses pelepasan tertunda karena pasien menunggu uji sensitivitas antibiotik untuk antibiotik intravena (IV) jangka panjang. 34 Sementara itu, lama rawat inap yang lebih panjang diperoleh pada penelitian pasien dengan osteomielitis hematogen akut yang memiliki ratarata lama rawat inap (length of stay) sebesar 24,7 hari. 24 Hal ini disebabkan osteomielitis hematogen akut merupakan infeksi bakteri parah di antara anak-anak, terutama di pra-sekolah atau sekolah karena memerlukan rawat inap dan pengobatan antibiotik untuk waktu yang lama serta menghasilkan gejala sisa permanen untuk sejumlah besar pasien.…”