title: [A multi-disciplinary approach to diabetic foot patients--an organizational model for the treatment of leg complications in diabetic patients].
abstract: Diabetes mellitus is the major cause of non-traumatic limb amputations in the Western world. In the diabetic foot patient, 85% have developed a leg ulcer prior to limb amputation. Due to the complicated nature of therapy in such patients, a multi-disciplinary approach is warranted. In this review, we describe an organizational model which provides an immediate solution to the factors involved in the evolution of a diabetic foot. At the end of 2002, The Wolfson Medical Center administration decided to centralize the diabetic foot patients into one unit situated in the Department of Medicine C. Ten beds were allocated for this purpose and situated at the far end of the department reducing the potential spread of infections to the rest of the ward. With the opening of the unit, a multi-disciplinary team was established that included internists, orthopedists, vascular surgeons, diabeticians, infectious disease specialists, and a specialized nursing staff that acquired their expertise while working with the medical staff and consultants including plastic surgeons and orthotists as required. With the initiation of the Diabetic Foot Unit, there was a reduction of 50% in major amputations in the unit when compared to the preceding years. During the years 2003-2004, the major amputation rate dropped to Less than 8%. Treatment of the diabetic foot patient is complex. In order to reduce the morbidity of limb amputation, a Diabetic Foot Unit is justified. In addition, specialized staff working in concert enable a synergistic effort that cannot be acquired individually. Most importantly, the amputation rate can be significantly reduced by utilizing the Diabetic Foot Unit model.
authors.affiliation: Department of Medicine C, E Wolfson Medical Center, Holon, Israel. goddard@wolfson.health.gov.il
authors.forename: Gisele
authors.initials: G
authors.lastname: Zandman-Goddard
authors.forename: Zeev
authors.initials: Z
authors.lastname: Feldbrin
authors.forename: Shmuel
authors.initials: S
authors.lastname: Ovadia
authors.forename: Tatiana
authors.initials: T
authors.lastname: Zubkov
authors.forename: Alexander
authors.initials: A
authors.lastname: Lipkin
authors.forename: Julio
authors.initials: J
authors.lastname: Wainstein
authors.forename: Hulio
authors.initials: H
authors.lastname: Vainstein
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration; D000671:Amputation, Surgical / Q000379:methods / Q000706:statistics & numerical data; D003428:Cross Infection / Q000517:prevention & control; D017719:Diabetic Foot / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007557:Israel; D017146:Models, Organizational; D010348:Patient Care Team / Q000458:organization & administration*