Endocrine Abstracts

Introduction: The National Diabetes Foot Care Audit (NHS Digital, 2019) employs the SINBAD score to evaluate patient care. According to NICE guidelines (2016), any patient with an ulcer should be referred to specialist services within one working day. This project aims to implement a systematic clinical assessment of diabetic foot patients using the SINBAD scoring system, develop appropriate investigation and management plans based on severity, and facilitate timely referrals to specialist teams to improve clinical outcomes, particularly in limb preservation.

Methodology: A retrospective data collection of 32 diabetic foot patients was conducted using Electronic Patient Records over three months from June to August 2024. Data included documenting risk factors, wound evaluation using the SINBAD score, necessary investigations, initiation of antibiotics within 1-2 hours, specialist consultations, and podiatrist/TVN review within 12 hours of presentation.

Results: Good practices identified included evidence of infection documented in 86% of patients, antibiotics initiated within 2 hours for 76%, and wound swabs sent for 64% of the cohort, with 72% receiving appropriate antibiotic reviews. Additionally, 69% were streamed directly to the Endocrine Ward from the Emergency Department. However, concerns arose with only 45% receiving X-rays upon admission, 55% lacking documented specialist discussions within 2-4 hours, and only 31% seen by a podiatrist/TVN within 12-24 hours. Nutritional blood and HbA1c checks were not performed for 72% and 79% of patients.

Conclusion: Our findings emphasise the need for structured assessment and timely intervention in managing diabetic foot patients. We developed a diabetic foot care pathway now accessible on the hospital intranet and integrated the SINBAD scoring system into the clerking document. Additionally, we displayed posters in clinical areas and organised teaching sessions for resident doctors. We aim to enhance clinical outcomes and reduce limb loss risk by implementing the SINBAD scoring system and improving referral processes.