Endocrine Abstracts

Background: There are nearly 5 million people with diabetes mellitus in the UK with an estimated 10% of diabetes patients developing a foot ulcer at some point in their lives. Nearly 9500 diabetes-related amputations are reported in the UK per year and approximately 80% of the NHS budget on diabetes care is spent on treating complications. Limb/life-threatening diabetic foot problems are referred to acute services immediately and all other active diabetic foot diseases are referred to Multi-Disciplinary Foot care service according to local protocols and pathways for triage.

Method: A generic referral proforma with patient demographics, the reason for referral and relevant clinical information was sufficient to complete the referral. We restructured the existing pro forma and added more care centric questions to assess clinical status and urgency. Specific information regarding recent wound swabs, imaging, lab investigations, current arterial status and offloading, were incorporated. Electronic records and referral Data were gathered prior and 8 months later after implementation of the new proforma.

Results: Improvement in the quality of patient care, as well as compliance with standards, was noted. Average waiting time for appointments was reduced by 15% and 17% for urgent and non-urgent referrals respectively. Nearly a quarter of the urgent referrals were identified as requiring assessment within 24 hrs. Patients, who had their wound swabs taken and lab investigations sent, increased from 30% & 27% to 68% and 72% respectively. In addition, more patients had off-loading and imaging done along with referrals.

Conclusion: A restructured referral form with specific care focused questions had the potential to improve the quality of patient care and to enhance compliance with standards.