title: Transformation of the multidisciplinary diabetic foot clinic into a multidisciplinary diabetic foot day unit: results from a service evaluation.
abstract: The natural history of the diabetic foot is aggressive and complex. To counteract this, we describe the transformation of a Multidisciplinary Diabetic Foot Clinic into a Multidisciplinary Diabetic Foot Day Unit, which delivers an emergency open access system for patients, with a "one-stop," same day service in which investigations are performed, results reviewed and treatment implemented. It also provides joint clinics with vascular, orthopaedic, and plastic surgeons and specialized clinics for casting of complex neuropathic feet and for the administration of intravenous or intramuscular antibiotics on the same day. The aim was to document these increasingly wide-ranging facilities by undertaking a retrospective evaluation over a 6-week period, with analysis of notes, investigations, and an anonymous patient satisfaction survey. The clinic was visited by 597 patients who attended in 1076 appointments, of which 112 (10.4%) were emergency visits; these patients attended the clinic without a booked appointment but via an open access policy, 93 of whom were known to the clinic, but 19 were new self-referred patients to the service. Furthermore, 197 (18%) were seen in a Joint Vascular Diabetic Foot Clinic and 98 (9%) were seen in a Joint Orthopaedic Plastic Diabetic Foot Clinic, 570 (53%) were seen in an Active Ulcer Clinic and 97 (9%) in a Total Contact Casting Clinic. Forty-five percent of patients were prescribed antibiotics, including 188 (76%) as oral and 45(18%) as intravenous antibiotics and 15(6%) as intramuscular injections. Of the 1076 appointments, 150 (14%) patients were in the foot clinic for more than 4 hours. Sixty (10%) patients were reviewed 4 or more times over the 6-week period. Only 22 (2%) were admitted to hospital. Of the 125 survey responders, 98% were satisfied with this service, which has evolved from a Diabetic Foot Clinic into a Multidisciplinary Diabetic Foot Day Unit.
authors.affiliation: King's College Hospital, London, UK Diabetes Department, King's College Hospital, London, UK chris.manu@nhs.net.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Manu
authors.affiliation: King's College Hospital, London, UK Diabetes Department, King's College Hospital, London, UK.
authors.forename: Omar G
authors.initials: OG
authors.lastname: Mustafa
authors.affiliation: King's College Hospital, London, UK Diabetes Department, King's College Hospital, London, UK.
authors.forename: Maureen
authors.initials: M
authors.lastname: Bates
authors.affiliation: King's College Hospital, London, UK Radiology Department, King's College Hospital, London, UK.
authors.forename: Gill
authors.initials: G
authors.lastname: Vivian
authors.affiliation: King's College Hospital, London, UK Radiology Department, King's College Hospital, London, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mulholland
authors.affiliation: King's College Hospital, London, UK Radiology Department, King's College Hospital, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Elias
authors.affiliation: King's College Hospital, London, UK Radiology Department, King's College Hospital, London, UK.
authors.forename: Dean Y
authors.initials: DY
authors.lastname: Huang
authors.affiliation: King's College Hospital, London, UK Vascular Laboratory, King's College Hospital, London, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Deane
authors.affiliation: King's College Hospital, London, UK Surgical Department, King's College Hospital, London, UK.
authors.forename: Naveen
authors.initials: N
authors.lastname: Cavale
authors.affiliation: King's College Hospital, London, UK Surgical Department, King's College Hospital, London, UK.
authors.forename: Venu
authors.initials: V
authors.lastname: Kavarthapu
authors.affiliation: King's College Hospital, London, UK Surgical Department, King's College Hospital, London, UK.
authors.forename: Hisham
authors.initials: H
authors.lastname: Rashid
authors.affiliation: King's College Hospital, London, UK Diabetes Department, King's College Hospital, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Edmonds
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D001071:Appointments and Schedules; D003430:Cross-Sectional Studies; D017719:Diabetic Foot / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012189:Retrospective Studies; D055815:Young Adult
keywords: diabetic foot clinic; foot day unit; foot emergency; one-stop assessment; open access