title: Diabetes outpatient care before and after admission for diabetic foot complications.
abstract: OBJECTIVE
  To assess the number of patients admitted with a diabetic foot complication to a regional teaching hospital over a 12-month period (July 2005 to June 2006) and determine the percentage that went though an optimal diabetes outpatient management pathway before and after this admission.
  
  
  METHODS
  Diabetic inpatients with foot ulcers and infections were identified through the relevant International Classification of Diseases (ICD) codes. Both inpatient and outpatient data were obtained through the local electronic patient management system and review of clinical notes.
  
  
  RESULTS
  Forty-nine patients were admitted to hospital with diabetic foot ulcers or infections during the audit period. Median age was 66 years and 67% were male. The most common admitting speciality was vascular surgery. The main associated procedure was toe amputation. In the six month period before and after the index admission, 63% of patients were seen by a health professional at the diabetes centre before or after the admission. 45% of patients were seen at the diabetes centre before and after the admission; 33% were seen by a podiatrist before and after the admission. However, 37% had no contact with the diabetes Centre and 51% did not see a podiatrist from the diabetes centre at any time during the six months before and after their admission.
  
  
  CONCLUSIONS
  Despite the availability of a multidisciplinary high risk foot clinic, only 45% of patients admitted to our regional hospital during the audit period followed an interdisciplinary pathway that included specialist diabetes input of some form and only 33% were assessed by a specialist diabetes podiatrist both before and after their hospital admission. A formalised patient pathway is likely to improve clinical management and may minimise further admissions. In this way it will help reduce morbidity and mortality in this high-risk patient group. In the future, this might best be achieved using an electronic referral and decision support system.
authors.affiliation: Department of Endocrinology, Christchurch Hospital, New Zealand. elna.ellis@cdhb.govt.nz
authors.forename: E
authors.initials: E
authors.lastname: Ellis
authors.forename: K
authors.initials: K
authors.lastname: Ballance
authors.forename: H
authors.initials: H
authors.lastname: Lunt
authors.forename: D
authors.initials: D
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration*; D054869:Clinical Audit; D019091:Critical Pathways / Q000458:organization & administration; D017719:Diabetic Foot / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009520:New Zealand / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000458:organization & administration*; D015397:Program Evaluation; D011787:Quality of Health Care / Q000458:organization & administration*; D012189:Retrospective Studies