A Multidisciplinary Approach to Diabetic Lower Limb Care
Diabetes is a growing problem both globally and nationally and the longevity of patients has dramatically impacted on the numbers of patients with diabetes presenting to Acute Hospitals (1). Devon CCG data demonstrates (April 2008- March 2011) 2334 episodes of inpatient care for diabetic foot disease. The Royal Devon & Exeter Foundation Trust experienced 50% of all these admissions (2). The aging population in the region impacts on the comorbidities and complexity of patients presenting to the Trust.
Patients with active foot or leg ulceration requiring wound care were historically managed by tissue viability and received wound advice and offloading; no formal assessment or podiatry input was available and there were poor links to the outpatient and community settings for follow up of these complex patients.
In December 2013, the Trust employed an inpatient diabetic podiatrist, as recommended by the National Institute of Clinical Excellence (3). Consequently practice has changed for these patients enabling diabetic foot ulcerations and lower limb pathology to be managed holistically between all the specialist teams. All referrals are now jointly triaged with allocation to the appropriate specialist. Complex patients with lower leg ulceration/pathology and diabetic foot ulceration are now jointly reviewed and links to the outpatient and community settings have improved.