Re-organizing inpatient care saves legs in patients with diabetic foot infections.
OBJECTIVE
In this study, we evaluated the effects of the re-organization of inpatient care for patients with a diabetic foot infection, and the implementation of a specialized multi-disciplinary wound department at an academic tertiary hospital.


METHODS
This was a retrospective cohort study, comprising 272 patients treated for diabetic foot infections in 2006-2007 (Group 1, n=124) and 2013-2014 (Group 2, n=148). In 2012, inpatient care of all chronic wounds was centralized at a single wound department with a multi-disciplinary team. We assessed group outcome before and after the re-organization.


RESULTS
During the 7-year study period, the incidence of hospitalized patients with a diabetic foot infection increased 19%. After initiating the re-organization, the below-the-knee amputation rate was significantly reduced (25.8% vs. 9.5%, p<0.001). The median time from admission to surgical intervention decreased from 5days to 2days, p<0.001. The length of hospitalization also tended to decrease after the reorganization.


CONCLUSIONS
The findings of this study demonstrate the benefits of treating diabetic foot infections at a specialized wound department with a multi-disciplinary team. The benefits were achieved by simply distributing the workload and organizing schedules, without new investments or additional personnel. The findings of this study indicate that patients with diabetic foot infections present a challenge that is beyond the expertise of a single field of medicine. A working collaboration between disciplines and a specialized wound department are central in achieving better results.
Tampere University Hospital, Department of Musculoskeletal Diseases, Finland. Electronic address: miska.laakso@gmail.com.
Miska
M
Laakso
Tampere University Hospital, Department of Musculoskeletal Diseases, Finland.
Mikael
M
Honkasalo
Tampere University Hospital, Department of Musculoskeletal Diseases, Finland.
Juha
J
Kiiski
Tampere University Hospital, Department of Dermatology and Allergology, Finland.
Meri
M
Ala-Houhala
Tampere University Hospital, Department of Musculoskeletal Diseases, Finland.
Heidi
H
Haapasalo
Tampere University Hospital, Department of Musculoskeletal Diseases, Finland.
Heikki-Jussi
HJ
Laine
Tampere University Hospital, Research and Innovation Center and University of Tampere, School of Health Sciences, Finland.
Tiina
T
Luukkaala
Tampere University Hospital, Department of Internal Medicine, Finland.
Jorma
J
Lahtela
Tampere University Hospital, Department of Musculoskeletal Diseases, Finland.
Ilkka
I
Kaartinen
D000368:Aged; D015331:Cohort Studies; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D006801:Humans; D007297:Inpatients; D007866:Leg / Q000473:pathology*; D008297:Male; D012189:Retrospective Studies; D014945:Wound Healing
Diabetic foot; Infection; Multi-disciplinary team; Wound; Wound department; Wound-center