1
|
Dhatariya K, Humberstone A, Hasnat A, Wright R, Lujan M, Nunney I. The Association Between Mean Glycated Haemoglobin or Glycaemic Variability and the Development of Retinopathy in People with Diabetes: A Retrospective Observational Cohort Study. Diabetes Ther 2021; 12:2755-2766. [PMID: 34491530 PMCID: PMC8479058 DOI: 10.1007/s13300-021-01146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/24/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION To determine the association between mean glycated haemoglobin (HbA1c) or glycaemic variability and the development of diabetic retinopathy (DR) in people with diabetes. METHODS An observational cohort study with people registered with a DR eye screening service between October 2012 and October 2017. Those who had no DR at the start of the study were followed for a maximum of 5 years. HbA1c measures were used to calculate HbA1c variability and mean HbA1c to assess any relationship between these and the risk of developing new onset DR. RESULTS A total of 2511 individuals were followed up for up to 5 years. Of these, 542 (21.6%) developed DR. After adjustment, HbA1c variability was not significantly associated with the development of DR (p = 0.3435). However, the mean HbA1c was (p < 0.0001). Those with type 1 diabetes had an odds of 1.63 (95% CI 1.11-2.40) of a retinopathy diagnosis compared to those with type 2 diabetes. CONCLUSIONS We have shown that mean HbA1c is associated with an increased risk of developing diabetic retinopathy. However, after adjustment for sex, age, diabetes type and the mean, the HbA1c variability no longer remained significant. Our data suggest that optimizing long-term glycaemic control remains paramount.
Collapse
Affiliation(s)
- Ketan Dhatariya
- Norwich Medical School, University of East Anglia, Medical Building, Norwich, Norfolk, NR4 7TJ, UK.
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
| | - Alexander Humberstone
- Norwich Medical School, University of East Anglia, Medical Building, Norwich, Norfolk, NR4 7TJ, UK
| | - Abul Hasnat
- Norwich Medical School, University of East Anglia, Medical Building, Norwich, Norfolk, NR4 7TJ, UK
| | - Rebecca Wright
- Norwich Medical School, University of East Anglia, Medical Building, Norwich, Norfolk, NR4 7TJ, UK
| | - Morgan Lujan
- Norwich Medical School, University of East Anglia, Medical Building, Norwich, Norfolk, NR4 7TJ, UK
| | - Ian Nunney
- Department of Medical Statistics, Norwich Medical School, Norwich, Norfolk, UK
| |
Collapse
|
2
|
The Association of Diabetes and Hyperglycemia on Inpatient Readmissions. Endocr Pract 2021; 27:413-418. [PMID: 33839023 DOI: 10.1016/j.eprac.2021.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/09/2020] [Accepted: 01/10/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the association between inpatient glycemic control and readmission in individuals with diabetes and hyperglycemia (DM/HG). METHODS Two data sets were analyzed from fiscal years 2011 to 2013: hospital data using the International Classification of Diseases, Ninth Revision (ICD-9) codes for DM/HG and point of care (POC) glucose monitoring. The variables analyzed included gender, age, mean, minimum and maximum glucose, along with 4 measures of glycemic variability (GV), standard deviation, coefficient of variation, mean amplitude of glucose excursions, and average daily risk range. RESULTS Of 66 518 discharges in FY 2011-2013, 28.4% had DM/HG based on ICD-9 codes and 53% received POC monitoring. The overall readmission rate was 13.9%, although the rates for individuals with DM/HG were higher at 18.9% and 20.6% using ICD-9 codes and POC data, respectively. The readmitted group had higher mean glucose (169 ± 47 mg/dL vs 158 ± 46 mg/dL, P < .001). Individuals with severe hypoglycemia and hyperglycemia had the highest readmission rates. All 4 GV measures were consistent and higher in the readmitted group. CONCLUSION Individuals with DM/HG have higher 30-day readmission rates than those without. Those readmitted had higher mean glucose, more extreme glucose values, and higher GV. To our knowledge, this is the first report of multiple metrics of inpatient glycemic control, including GV, and their associations with readmission.
Collapse
|
3
|
Lawler J, Trevatt P, Elliot C, Leary A. Does the Diabetes Specialist Nursing workforce impact the experiences and outcomes of people with diabetes? A hermeneutic review of the evidence. HUMAN RESOURCES FOR HEALTH 2019; 17:65. [PMID: 31391081 PMCID: PMC6686398 DOI: 10.1186/s12960-019-0401-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/19/2019] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The aim of the hermeneutic review was to identify and clarify the mechanisms by which the Diabetes Specialist Nursing workforce affect the outcomes of diabetes patients, with a focus on those in the United Kingdom. A clarification of diabetes specialist nurses' work is necessary in understanding and improving diabetes inpatient care. DESIGN The design is a hermeneutic evidence review and was part of a wider evaluation of Diabetes Inpatient Specialist Nurses for which the evidence was sourced. The literature search was limited to specialist nursing workforce caring for adults with diabetes. In order to gain global understanding of the impact of specialist nursing in diabetes, worldwide literature was included. METHODS A hermeneutic literature review of 45 publications was carried out, which included citation analysis. Relevant literature was identified from 1990 to 2018. RESULTS Evidence suggests that Diabetes Specialist Nurses educate patients and other healthcare professionals as well as delivering direct care. The outcomes of these actions include a reduced patient length of stay in hospital, reduced inpatient harms and complications, and improved patient satisfaction. Additionally, they are cost-effective. CONCLUSIONS The Diabetes Specialist Nursing workforce is essential in diabetes care, particularly in hospital settings. They improve patient experience and outcomes.
Collapse
Affiliation(s)
- Jessica Lawler
- London South Bank University, School of Health and Social Care, 103 Borough Rd, London, SE1 0AA, United Kingdom.
| | - Paul Trevatt
- Cardiovascular Disease/End of Life Care, Clinical Networks, NHS England (London region), London, United Kingdom
| | - Clare Elliot
- South West London Health & Care Partnership, London, United Kingdom
| | - Alison Leary
- London South Bank University, School of Health and Social Care, 103 Borough Rd, London, SE1 0AA, United Kingdom
| |
Collapse
|
4
|
Fry W, McCafferty S, Gooday C, Nunney I, Dhatariya KK. Assessing the Effect of Piperacillin/Tazobactam on Hematological Parameters in Patients Admitted with Moderate or Severe Foot Infections. Diabetes Ther 2018; 9:219-228. [PMID: 29302933 PMCID: PMC5801243 DOI: 10.1007/s13300-017-0357-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Piperacillin/tazobactam is a commonly used antibiotic for the empirical treatment of severe diabetic foot infections. One of the most feared complications of this drug is the development of pancytopenia. The aim of this study was to determine whether the use of piperacillin/tazobactam caused any hematological changes in patients admitted with severe diabetes-related foot infections from a specialist multidisciplinary foot clinic. Specifically, looking at whether it caused anemia, leukopenia, neutropenia, or thrombocytopenia. METHODS A 1-year retrospective analysis of patients admitted to a tertiary care center for treatment of diabetes-related foot infection using piperacillin/tazobactam. Hematological indices, urea and electrolytes, and C-reactive protein (CRP) were recorded pretreatment, during treatment, and posttreatment. HbA1c, vitamin B12, folate, thyroid-stimulating hormone, and free thyroxin were also analyzed to exclude any potential confounders as a cause of pancytopenia. RESULTS A total of 154 patients were admitted between 1 January 2016 and 31 December 2016 who received piperacillin/tazobactam for severe diabetes-related foot infection. On admission, white cell count and CRP were raised and fell significantly within the first 48 h. Other hematological factors did not change. Five patients developed a mild pancytopenia, of which three were unexplained. CONCLUSION In this relatively small cohort, pancytopenia did not occur. As such, piperacillin/tazobactam appeared to have a low risk of adverse hematological outcomes and remains the treatment of choice for severe diabetes-related foot infections.
Collapse
Affiliation(s)
- Will Fry
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Sean McCafferty
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Catherine Gooday
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK
| | - Ian Nunney
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Ketan K Dhatariya
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK.
| |
Collapse
|
5
|
Inadequate pre-operative glycaemic control in patients with diabetes mellitus adversely influences functional recovery after total knee arthroplasty : Patients with impaired glycaemic control exhibit poorer functional outcomes at 1-year post-arthroplasty. Knee Surg Sports Traumatol Arthrosc 2017; 25:1801-1806. [PMID: 27502788 DOI: 10.1007/s00167-016-4249-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 07/27/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE Whilst inadequate glycaemic control is associated with an increase in perioperative complications following total knee arthroplasty, the impact of glycaemic control in this at-risk patient group remains ill-defined. Identification of at-risk patients would allow targeted pre-operative glycaemic control intervention. METHODS One hundred consecutive patients with a diagnosis of diabetes mellitus and one hundred age, sex and BMI matched patients without diabetes undergoing total knee arthroplasty in a single institution were analysed between 2008 and 2013. Inadequate glycaemic control was defined as having an HbA1c of greater than 64 mmol/mol (8.0 % NGSP) measured within the 3 months before surgery. Patient demographics, diabetes management and complications of diabetes were recorded and used as explanatory variables to deliver a generalised linear model. This allows for relationships to be defined between change in patient-reported function (SF-36, WOMAC) and these explanatory variables. RESULTS The patient group with concomitant diabetes exhibited smaller improvements in WOMAC and SF-36 physical component summary at 1 year after knee arthroplasty. This effect was most pronounced in the subset of patients with inadequate glycaemic control recorded in the early pre-operative period. CONCLUSION Patients with diabetes, particularly those with inadequate glycaemic control, exhibit less improvement at 1 year following knee arthroplasty than patients without diabetes mellitus. Clinical focus on modulating this factor in this at-risk group is warranted. LEVEL OF EVIDENCE III.
Collapse
|
6
|
Essackjee Z, Gooday C, Nunney I, Dhatariya K. Indicators of prognosis for admissions from a specialist diabetic foot clinic: a retrospective service improvement exercise. J Wound Care 2017; 26:40-45. [PMID: 28103162 DOI: 10.12968/jowc.2017.26.1.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To look at haematological and biochemical variables as predictors of outcomes in people admitted to hospital with a diabetic foot ulcer (DFU) without the use of technology or devices. In particular, to see if there was a relationship between admission blood cell and protein levels, and the likelihood of angioplasty, amputation, and death at one year after admission. METHOD A five-year retrospective analysis of patients admitted to a tertiary multidisciplinary specialist diabetic foot clinic looking at admission C-reactive protein (CRP), white cell count (WCC), neutrophil count and HbA1c and their relationship to likelihood of angioplasty, minor or major amputation, and death at one year after admission. RESULTS We identified 206 patients, in whom there was 1 year mortality rate of 6.3%. Raised WCC and CRP levels were significantly associated with major amputation (p=0.0035 and p<0.01, respectively). Raised WCC and neutrophil levels and were significantly associated with mortality (p=0.01 and p=0.002, respectively). The need for angioplasty was associated with raised CRP (p<0.05) but not with WCC or neutrophil count. There was no association of risk of minor amputations with admission HbA1c, CRP, WCC and neutrophils. Mean length of hospital stay was 17.5 (standard deviation ±14.0) days. CONCLUSION Commonly measured haematological and biochemical markers were useful predictors of outcomes for patients admitted to hospital for acute foot wounds. In addition, we found a much lower 1 year mortality and shorter length of hospital stay than previously recorded, possibly due to the introduction of a multidisciplinary weekly ward round.
Collapse
Affiliation(s)
- Z Essackjee
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - C Gooday
- Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - I Nunney
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - K Dhatariya
- Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| |
Collapse
|
7
|
Akirov A, Dicker D, Shochat T, Shimon I. Mortality risk in admitted patients with diabetes mellitus according to treatment. J Diabetes Complications 2016; 30:1025-31. [PMID: 27138870 DOI: 10.1016/j.jdiacomp.2016.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 01/04/2023]
Abstract
AIMS Investigate the importance of treating diabetes by evaluating mortality risk of untreated and medically-treated diabetic patients. METHODS Historical prospectively collected observational data of hospitalized patient ≥18years, admitted for any-cause to medical wards, between January 2011 and December 2013. Main outcome was all-cause mortality at end of follow-up. RESULTS Cohort included 35,340 patients (51% male, median age 70years); 24,159 without diabetes and 11,181 with diabetes. Within the diabetic group, 2,188 patients (20%) were not receiving medical treatment for diabetes and 8993 were being treated as follows: 4550 (41%) non-insulin monotherapy; 1550 (14%) non-insulin combination therapy; 2,893 (26%) insulin. Hazard ratios were compared for the entire follow-up, indicating a significant difference in overall survival between medically untreated DM and all groups, except insulin-treated. Subset analysis with adjustment for age, gender, BMI, alcohol and smoking indicated a significant survival difference between untreated DM and all groups. Rates of hypertension, ischemic heart disease, renal failure, and congestive heart disease were higher in the untreated and insulin-treated diabetic patients than in the nondiabetic and diabetic patients on non-insulin treatment. CONCLUSIONS Lack of treatment for diabetes might have serious consequences. Further studies are needed to see if targeted treatment approach may decrease mortality.
Collapse
Affiliation(s)
- Amit Akirov
- Institute of Endocrinology, Rabin Medical Center - Beilinson Hospital, Petach Tikva 49100; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Dror Dicker
- Department of Internal Medicine D, Rabin Medical Center - Beilinson Hospital, Petach Tikva 49100; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tzipora Shochat
- Statistical Consulting Unit, Rabin Medical Center, Beilinson Hospital
| | - Ilan Shimon
- Institute of Endocrinology, Rabin Medical Center - Beilinson Hospital, Petach Tikva 49100; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
8
|
Lazzarini PA, Hurn SE, Fernando ME, Jen SD, Kuys SS, Kamp MC, Reed LF. Prevalence of foot disease and risk factors in general inpatient populations: a systematic review and meta-analysis. BMJ Open 2015; 5:e008544. [PMID: 26597864 PMCID: PMC4663442 DOI: 10.1136/bmjopen-2015-008544] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To systematically review studies reporting the prevalence in general adult inpatient populations of foot disease disorders (foot wounds, foot infections, collective 'foot disease') and risk factors (peripheral arterial disease (PAD), peripheral neuropathy (PN), foot deformity). METHODS A systematic review of studies published between 1980 and 2013 was undertaken using electronic databases (MEDLINE, EMBASE and CINAHL). Keywords and synonyms relating to prevalence, inpatients, foot disease disorders and risk factors were used. Studies reporting foot disease or risk factor prevalence data in general inpatient populations were included. Included study's reference lists and citations were searched and experts consulted to identify additional relevant studies. 2 authors, blinded to each other, assessed the methodological quality of included studies. Applicable data were extracted by 1 author and checked by a second author. Prevalence proportions and SEs were calculated for all included studies. Pooled prevalence estimates were calculated using random-effects models where 3 eligible studies were available. RESULTS Of the 4972 studies initially identified, 78 studies reporting 84 different cohorts (total 60 231 517 participants) were included. Foot disease prevalence included: foot wounds 0.01-13.5% (70 cohorts), foot infections 0.05-6.4% (7 cohorts), collective foot disease 0.2-11.9% (12 cohorts). Risk factor prevalence included: PAD 0.01-36.0% (10 cohorts), PN 0.003-2.8% (6 cohorts), foot deformity was not reported. Pooled prevalence estimates were only able to be calculated for pressure ulcer-related foot wounds 4.6% (95% CI 3.7% to 5.4%)), diabetes-related foot wounds 2.4% (1.5% to 3.4%), diabetes-related foot infections 3.4% (0.2% to 6.5%), diabetes-related foot disease 4.7% (0.3% to 9.2%). Heterogeneity was high in all pooled estimates (I(2)=94.2-97.8%, p<0.001). CONCLUSIONS This review found high heterogeneity, yet suggests foot disease was present in 1 in every 20 inpatients and a major risk factor in 1 in 3 inpatients. These findings are likely an underestimate and more robust studies are required to provide more precise estimates.
Collapse
Affiliation(s)
- Peter A Lazzarini
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia Wound Management Innovation Cooperative Research Centre, Brisbane, Queensland, Australia
| | - Sheree E Hurn
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Malindu E Fernando
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia Podiatry Service, Kirwan Community Health Campus, Townsville Hospital and Health Service, Townsville, Queensland, Australia
| | - Scott D Jen
- Department of Podiatry, West Moreton Hospital & Health Service, Ipswich, Queensland, Australia
| | - Suzanne S Kuys
- Allied Health Research Collaborative, Metro North Hospital & Health Service, Brisbane, Queensland, Australia Centre for Musculoskeletal Research, Griffith Health Institute, Griffith University, Gold Coast, Australia
| | - Maarten C Kamp
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lloyd F Reed
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
9
|
Plusch D, Penkala S, Dickson HG, Malone M. Primary care referral to multidisciplinary high risk foot services - too few, too late. J Foot Ankle Res 2015; 8:62. [PMID: 26582352 PMCID: PMC4650286 DOI: 10.1186/s13047-015-0120-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 11/01/2015] [Indexed: 11/10/2022] Open
Abstract
Background To determine if patients with no contact with a multi-disciplinary team High Risk Foot Service (MDT-HRFS) had an increased rate of hospital admission for diabetes foot infection compared to patients with contact. Secondary aims were to report on clinical outcomes. Methods A retrospective study was conducted at a major tertiary referral hospital in metropolitan Sydney over 12 months. An ICD-10 search of the electronic medical record system and paper medical charts identified patients with diabetes mellitus (type 1 or type 2) and a primary admission for diabetes foot infection (DFI). Patients were categorised as having contact or no contact with an MDT-HRFS. Results One hundred ninety-six hospital admissions (156 patients) were identified with DFI over a 12-month period. Patients with no contact with a MDT-HRFS represented three quarters of admissions (no contact = 116, 74.7 % vs. contact = 40, 25.6 %, p = 0.0001) and presented with more severe infection (no contact = 39 vs. contact = 12). The odds of lower extremity amputation increased five-fold when both no contact and severe infection occurred in combination (no contact with severe infection and amputation = 34, 82.9 % vs. contact with severe infection and amputation = 7, 17.1 %, OR 4.9, 95 % CI 1.1–21.4, p = 0.037). Using estimates of both the contact and no contact population of people with diabetes and high-risk feet and assuming the risk of amputation was the same, than the number of expected amputations in the no contact group should have been 55, however the observed number was 77, 22 more than expected (p = 0.0001). Conclusions Patients with no contact with a MDT-HRFS represented the majority of admissions for DFIs to a tertiary referral hospital. This group on population estimates appears to be at high risk of amputation of the lower extremity and therefore early referral of this high-risk group might lower this risk.
Collapse
Affiliation(s)
- D Plusch
- Western Sydney University, Campbelltown Campus, Campbelltown, Sydney, NSW 2560 Australia
| | - S Penkala
- Western Sydney University, Campbelltown Campus, Campbelltown, Sydney, NSW 2560 Australia ; LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW 2170 Australia
| | - H G Dickson
- Ambulatory Care, Liverpool Hospital, Locked Bag 7103, Liverpool, NSW 2170 Australia ; LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW 2170 Australia
| | - M Malone
- Western Sydney University, Campbelltown Campus, Campbelltown, Sydney, NSW 2560 Australia ; Department of Podiatric Medicine, High Risk Foot Service, Liverpool Hospital, Locked Bag 7103, Liverpool, NSW 2170 Australia ; LIVE DIAB CRU, Ingham Institute of Applied Medical Research, Liverpool, NSW 2170 Australia
| |
Collapse
|
10
|
Cichero MJ, Bower VM, Walsh TP, Yates BJ. Reducing length of stay for acute diabetic foot episodes: employing an extended scope of practice podiatric high-risk foot coordinator in an acute foundation trust hospital. J Foot Ankle Res 2013; 6:47. [PMID: 24330601 PMCID: PMC4029194 DOI: 10.1186/1757-1146-6-47] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 12/09/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To enhance the acute management of people with diabetic foot disease requiring admission, an extended scope of practice, podiatric high-risk foot coordinator position, was established at the Great Western Hospital, Swindon in 2010. The focus of this new role was to facilitate more efficient and timely management of people with complex diabetic foot disease. The aim of this project was to investigate the impact of the podiatric high-risk foot coordinator role on length of stay, rate of re-admission and bed cost. METHOD This study evaluated the difference in length of stay and rate of re-admission between an 11- month pre-pilot period (November 2008 to October 2009) and a 10-month pilot period (August 2010 to June 2011). The estimated difference in bed cost between the pre-pilot and pilot audits was also calculated. Inclusion criteria were restricted to inpatients admitted with a diabetic foot ulcer, gangrene, cellulitis or infection as the primary cause for admission. Eligible records were retrieved using ICD-10 (V9) coding via the hospital clinical audit department for the pre-pilot period and a unique database was used to source records for the pilot phase. RESULTS Following the introduction of the podiatric high-risk foot coordinator, the average length of stay reduced from 33.7 days to 23.3 days (mean difference 10.4 days, 95% CI 0.0 to 20.8, p = 0.050). There was no statistically significant difference in re-admission rate between the two study periods, 17.2% (95% CI 12.2% to 23.9%) in the pre-pilot phase and 15.4% (95% CI 12.0% to 19.5%) in the pilot phase (p = 0.820). The extrapolated annual cost saving following the implementation of the new coordinator role was calculated to be £234,000 for the 2010/2011 year. CONCLUSIONS This audit found that the extended scope of practice coordinator role may have a positive impact on reducing length of stay for diabetic foot admissions. This paper advocates the role of a podiatric high-risk foot coordinator utilising an extended scope of practice model, although further research is needed.
Collapse
Affiliation(s)
| | - Virginia M Bower
- School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, Australia.
| | | | | |
Collapse
|
11
|
Gooday C, Murchison R, Dhatariya K. An analysis of clinical activity, admission rates, length of hospital stay, and economic impact after a temporary loss of 50% of the non-operative podiatrists from a tertiary specialist foot clinic in the United Kingdom. Diabet Foot Ankle 2013; 4:21757. [PMID: 24040488 PMCID: PMC3772317 DOI: 10.3402/dfa.v4i0.21757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/02/2013] [Accepted: 08/03/2013] [Indexed: 11/14/2022]
Abstract
Introduction Podiatrists form an integral part of the multidisciplinary foot team in the treatment of diabetic foot–related complications. A set of unforeseen circumstances within our specialist diabetes foot service in the United Kingdom caused a loss of 50% of our non-operative podiatry team for almost 7 months during 2010. Some of this time was filled by non-specialist community non-operative podiatrists. Methods We assessed the economic impact of this loss by examining data for the 5 years prior to this 7-month interruption, and for the 2 years after ‘normal service’ was resumed. Results Our data show that the loss of the non-operative podiatrists led to a significant rise in the numbers of admissions into hospital, and hospital length of stay also increased. At our institution a single bed day cost is £275. During the time that the numbers of specialist non-operative podiatry staff were depleted, and for up to 6 months after they returned to normal activities, the extra costs increased by just less than £90,000. The number of people admitted directly from specialist vascular and orthopaedic clinics is likely to have increased due to the lack of capacity to manage them in the diabetic foot clinic. Our data were unable to assess these individuals and did not look at the costs saved from avoiding surgery. Thus the actual costs incurred are likely to be higher. Conclusions Our data suggest that specialist non-operative podiatrists involved in the treatment of the diabetic foot may prevent unwarranted hospital admission and increased hospitalisation rates by providing skilled assessment and care in the outpatient clinical settings.
Collapse
Affiliation(s)
- Catherine Gooday
- Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norwich, Norfolk, UK
| | | | | |
Collapse
|