Determining the need for inpatient podiatry service for people with acute diabetic foot disease
Jessica Rees, Advanced Inpatient Podiatry Coordinator, Cwm Taf Morgannwg Health Board
Introduction
Active foot problems in people with diabetes have significant financial impacts on the NHS, with costs for diabetic foot ulceration (DFU) and amputation in England estimated between £837 million and £962 million in 2014-15.
DFU patients experience longer hospital stays, yet evidence shows that only one-third receive a foot examination within 24 hours of admission. With no dedicated podiatry inpatient service, timely responses were not provided and education for ward staff was lacking. The aim is to ensure that 80% of inpatients with active diabetic foot disease are reviewed by a podiatrist within one working day of admission by March 2024.
Methods
A Pareto analysis at the Royal Glamorgan Hospital identified that the main causes of delayed referrals to specialist podiatry services were a lack of understanding of the referral pathway and criteria. To address this, stakeholders including nursing and medical teams were involved in developing clear referral criteria and pathways for patients with acute diabetic foot problems. These were disseminated through awareness sessions, training, and meetings, with posters displayed in clinical areas to reinforce the process.
This ensures timely referrals in line with Getting It Right First Time (GIRFT) pathway and NICE NG19 guidance, reducing treatment delays and potentially shortening hospital stays. Awareness sessions and posters were tested via PDSA cycles.
Outcomes
- Referral response rates improved significantly: 92% within 1 working day in the first 6 months, 96.4% in the next 6 months. Prior to the project, only 63% of referrals were seen within 1 working day.
- PREMS surveys show high satisfaction rates from service users.
- Timely referrals support appropriate treatment planning, imaging, and specialist referrals, reducing hospital stays and facilitating safe discharges.
- Rapid response at ED/AECU ensures optimal management and care, often avoiding unnecessary admissions.
Learnings
- The advanced inpatient podiatry coordinator role was beneficial to ensure prompt assessments and facilitating quicker decision-making.
- Earlier involvement of senior nursing and medical teams could have accelerated the rollout of education and awareness of the service.
- Delays in reviewing and ratifying the screening tool hindered its early implementation.
- Collecting baseline data before the project would have helped demonstrate measurable improvements.
- PREMS survey results should be continually reviewed to assess patient experience and the value of the service.
What next?
- Ongoing staff education and awareness sessions are essential for prompt referrals.
- A diabetic foot risk screening tool is being piloted
- Project aims to improve patient outcomes, experience, and clinical efficiency, supporting the need for a permanent, dedicated inpatient podiatry service across multiple sites.
