Endocrine Abstracts

Background: In any given week, 2.5% of diabetic patients have a foot ulcer. In the United Kingdom (UK), there are 7000 lower limb amputations in people with diabetes every year and the annual NHS expenditure on diabetic foot-related healthcare amounts to £1 billion. As per the National Institute for Health and Care Excellence guidelines in the UK, a person with diabetes needs to be referred to an MDT within 24 h of finding a foot ulcer. The National Diabetes Footcare Audit demonstrates better outcomes at 12 weeks for patients with a new diabetic foot ulcer referred early for MDT input. The early identification of patients with a diabetic foot ulcer and a timely referral to the MDT is therefore vital.

Methods: A two-cycle quality improvement project, with retrospective data collection before and after our intervention, was carried out at our hospital with the aim of improving identification of patients and quality of referrals. Those information mainly included ulcer charateristics, past medical history and investigations. An online referral system with a pre-set questions was then introduced along with teaching sessions delivered to the acute medical team. The results were analysed and presented to the endocrinology and diabetes department.

Results: Our results showed that the average monthly number of referrals was 10.3 for the first cycle and 12.5 for the second cycle. The average referral time was 8.3 days for the first cycle and 4.2 days for the second cycle. Size of ulcer reporting improved from 6.5% to 64%, depth of ulcer from 9.7% to 12.0% and position of ulcer from 74.19% to 80.0%. Mention of peripheral vascular disease improved from 9.7% to 20.0%, presence of pulse from 12.9% to 100% and presence of neuropathy from 12.9% to 100.0%. For investigations, mention of microbiology culture results improved from 12.9% to 40.0% and imaging from 22.6% to 60.0%.

Conclusion: There has been an improvement in the time from admission until referral although more work needs to be done to improve the time to within the 24 hour window. The online referral system helped to improve the quality of information of the referral with regards to information on ulcer characteristics, past medical history and investigations. Improved quality of referrals allow for a more efficient MDT functioning and more timely management strategies for patient outcomes. We intend to further continue this project to look at the effect of the referral system on patient outcomes.