title: An analysis of clinical activity, admission rates, length of hospital stay, and economic impact after a temporary loss of 50% of the non-operative podiatrists from a tertiary specialist foot clinic in the United Kingdom.
abstract: BACKGROUND
  Podiatrists form an integral part of the multidisciplinary foot team in the treatment of diabetic foot-related complications. A set of unforeseen circumstances within our specialist diabetes foot service in the United Kingdom caused a loss of 50% of our non-operative podiatry team for almost 7 months during 2010. Some of this time was filled by non-specialist community non-operative podiatrists.
  
  
  METHODS
  We assessed the economic impact of this loss by examining data for the 5 years prior to this 7-month interruption, and for the 2 years after 'normal service' was resumed.
  
  
  RESULTS
  Our data show that the loss of the non-operative podiatrists led to a significant rise in the numbers of admissions into hospital, and hospital length of stay also increased. At our institution a single bed day cost is £275. During the time that the numbers of specialist non-operative podiatry staff were depleted, and for up to 6 months after they returned to normal activities, the extra costs increased by just less than £90,000. The number of people admitted directly from specialist vascular and orthopaedic clinics is likely to have increased due to the lack of capacity to manage them in the diabetic foot clinic. Our data were unable to assess these individuals and did not look at the costs saved from avoiding surgery. Thus the actual costs incurred are likely to be higher.
  
  
  CONCLUSIONS
  Our data suggest that specialist non-operative podiatrists involved in the treatment of the diabetic foot may prevent unwarranted hospital admission and increased hospitalisation rates by providing skilled assessment and care in the outpatient clinical settings.
authors.affiliation: Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norwich, Norfolk, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Gooday
authors.forename: Rachel
authors.initials: R
authors.lastname: Murchison
authors.forename: Ketan
authors.initials: K
authors.lastname: Dhatariya
keywords: diabetes; economic value; foot clinic; multidisciplinary team; podiatrist
references.citation: Diabetes Care. 2008 Jan;31(1):99-101
references.pmid: 17934144
references.citation: Diabet Med. 2013 May;30(5):581-9
references.pmid: 23210933
references.citation: J Am Podiatr Med Assoc. 2011 Mar-Apr;101(2):93-115
references.pmid: 21406693
references.citation: JRSM Short Rep. 2011 Nov;2(11):83
references.pmid: 22140609
references.citation: Q J Med. 1986 Aug;60(232):763-71
references.pmid: 3774959