Volume 04 / Issue 03 / September 2016
Page 36
boa.ac.uk
JTO Features
New Guidelines for Diabetic Feet Fred Robinson Co-author: Kevin Varty, Consultant Vascular Surgeon, Addenbrooke’s NHS Trust
The cost of diabetic foot care is estimated to be £615 million per annum; or £1 in every £150 spent in the NHS is on the diabetic foot - a truly shocking figure! We cannot ignore this group of patients financially or on grounds of need - it is estimated that 50% of patients with a diabetic foot ulcer die within five years.
Centralisation of vascular services into a hub and spoke model has been implemented to improve the quality of care, facilitate training and support sustainable rotas. The centralisation of major arterial interventions has the potential to disrupt service provision unless managed carefully. This has been a major concern to many involved in the treatment of patients with diabetic foot disease. Vascular networks aim to deliver local diagnostic, daycase and rehabilitation care, with transfer to the arterial centre being reserved for higher risk invasive procedures. For vulnerable diabetic foot patients, the question is, can such arrangements still deliver care of an appropriate quality in their local hospitals? We believe the answer to this question is yes, if appropriate structures are put into place.
Fred Robinson
The BOA, BOFAS, the Vascular Society, Diabetes UK, the Association of British Clinical Diabetologists, Foot in Diabetes UK and the British Association of Prosthetists and Orthotists have collaborated to produce a consensus document – ‘Operational Delivery of the Multidisciplinary Care Pathway for Diabetic Foot Problems.’ These
guidelines can be found on the NHS England, the BOA and the BOFAS websites. It is hoped that these guidelines will help, and not hinder, the development of your services - if you had a structure that works - keep using it! The guidelines have the following points at their core: l The Vascular Society accepts
that the vascular network has a duty to maintain a significant presence in the spokes so that a vascular opinion is readily available on site for the nonemergency cases; l Many cases do not need immediate intervention and will continue to be admitted for antibiotic treatment and elevation, wherever they present; l Those patients with ischaemia will need urgent discussion with the vascular services. It is important that the pathways for discussion are easily accessible; l Patients without vascular compromise presenting to the spoke hospital with an abscess or collection in the foot will need intervention, occasionally as an emergency out of hours. For these cases it is anticipated that orthopaedic surgery will provide the acute surgical service;
l At times this will mean non-foot
and ankle specialists draining foot abscesses. The BOA and BOFAS are working together to produce a one-page guideline on the surgical treatment of a patient with a foot abscess; l The BOA’s Training Standards Committee is working on producing a critical case-based discussion on the acute diabetic foot. Central to this will be the swift taking over of care of these patients by the diabetologists and foot and ankle surgeons after the night/weekend on call. We hope that you, either as a foot and ankle specialist, or not, find these guidelines helpful. We are sure that you will agree that this is an important group of patients who deserve orthopaedic care. With appropriate structures in place and clear pathways, we can hopefully save both life and limb. Please take the time to read the document. n Fred Robinson is a Consultant Orthopaedic Surgeon at Addenbrooke’s Hospital, Cambridge. He has run the foot and ankle service for 15 years. He is Past President of BOFAS and is a trustee of the BOA.