[Impact of a clinical pathway for the diabetic foot in a general hospital].
OBJECTIVE
The ulcers, infections and isquemia of the foot are the main causes of hospitalisation of the diabetic patient and, very frequently, they are reason for the amputation of the limb. The objective of this investigation consists of evaluating the results of a multidisciplinary clinical pathway designed by the set of specialists of different departments from our hospital, as well as of the associated personnel of infirmary, implied in the management of this pathology.


METHODS
We have analysed the evolution of a series of clinical and socio-economic indicators comparing, in the patients admitted with diagnose of complicated diabetic foot, the previous period to the implantation of the clinical pathway years 1998, 1999 and 2000) with the later period to this implantation (years 2001 and 2002). It is evaluated in each group: the percentage of greater and smaller amputations, mortality, the average stay, the percentage of readmitances in 30 days, the percentage of arteriographies, the percentage of patients controlled by rehabilitation, and the economic cost of the individual processes, as well as the global cost. In the group including in the clinical pathway it was carried out, in addition, a satisfaction survey. The statistical comparison was made by means of the Chi square test.


RESULTS
We did not find differences as far as the average stay, nor to intrahospitable mortality. If we found a clear increase in the percentage of arteriographies (of the 3.5% passage to 13%), and in the percentage of patients controlled by rehabilitation (of the 19.8% passage to the 84.3%). The rate of greater amputations of the patients not including in the clinical pathway change from 17.4% to 9.7% after the implantation of this route. The rate of readmitances to 30 days diminished from 9.3 to 6,5%. The global economic cost and the average cost by patient have been inferior after the implantation of the clinical route. The survey of satisfaction of this last group offered a global satisfaction of 95%.


CONCLUSIONS
The results suggest that the approach to the diagnose and treatment on the complicated diabetic foot by means of this multidisciplinary clinical pathway improves the evolution of the hospitalised patient, diminishing the number of greater amputations, without extending the average stay and maintaining, or even diminishing, the global economic cost.
Martínez
D A
DA
Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Morales Meseguer, Murcia.
Aguayo
J l
Jl
Morales
G
G
Aguirán
M l
Ml
Illán
F
F
D000671:Amputation, Surgical; D017281:Cost of Illness; D019091:Critical Pathways; D017719:Diabetic Foot / Q000191:economics / Q000517:prevention & control*; D006801:Humans; D011787:Quality of Health Care; D013030:Spain