title: Value of team approach combined with clinical pathway for diabetic foot problems: a clinical evaluation.
abstract: OBJECTIVE
  To evaluate the effectiveness of management of diabetic foot problems (DFP) by the National University Hospital (NUH) Multidisciplinary Diabetic Foot Team combined with a clinical pathway in terms of average length of stay (ALOS), readmission rates, hospitalisation cost per patient, major reamputation rate, and complication rate.
  
  
  METHODS
  939 patients admitted to the Department of Orthopaedic Surgery, NUH, for DFP from 2002 (before team formation) to 2007 (after team formation). It consisted of six cohorts of patients - 61 for 2002, 70 for 2003, 148 for 2004, 180 for 2005, 262 for 2006, and 218 for 2007. All patients were managed by the NUH Multidisciplinary Diabetic Foot Team combined with a clinical pathway. Statistical analyses were carried out for five parameters (ALOS, hospitalisation cost per patient, major amputation rate, readmission rate, and complication rate).
  
  
  RESULTS
  From 2002 to 2007, the ALOS was significantly reduced from 20.36 days to 12.20 days (p=0.0005). Major amputation rate was significantly reduced from 31.15 to 11.01% (p<0.0005). There was also a significant reduction in complication rate from 19.67 to 7.34% (p=0.005). There were reductions in the hospitalisation cost per patient and readmission rate after formation of the multidisciplinary team but they were not statistically significant.
  
  
  CONCLUSIONS
  Our evaluation showed that a multidisciplinary team approach combined with the implementation of a clinical pathway in NUH was effective in reducing the ALOS, major amputation rate, and complication rate of DFP.
authors.affiliation: Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Aziz
authors.initials: A
authors.lastname: Nather
authors.forename: Chionh
authors.initials: C
authors.lastname: Siok Bee
authors.forename: Wong
authors.initials: W
authors.lastname: Keng Lin
authors.forename: Chan
authors.initials: C
authors.lastname: Xin-Bei Valerie
authors.forename: Shen
authors.initials: S
authors.lastname: Liang
authors.forename: Paul A
authors.initials: PA
authors.lastname: Tambyah
authors.forename: Adam
authors.initials: A
authors.lastname: Jorgensen
authors.forename: Ajay
authors.initials: A
authors.lastname: Nambiar