Re-organizing inpatient care saves legs in patients with diabetic foot infections. (March 2017)

• Record Type: Journal Article
• Authors: Laakso, Miska; Honkasalo, Mikael; Kiiski, Juha; Ala-Houhala, Meri; Haapasalo, Heidi; Laine, Heikki-Jussi; Luukkaala, Tiina; Lahtela, Jorma; Kaartinen, Ilkka
• Is Part Of: Diabetes research and clinical practice. Volume 125(2017)
• Page Start: 39
• Page End: 46
• Publication Date: 2017-03
• Subjects: Diabetic foot -- Wound -- Infection -- Wound-center -- Wound department -- Multi-disciplinary team; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2017.01.007
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: Wound department improved results with hospitalized diabetic foot infections. Rate of major amputations and delay for first surgery was reduced. Multidisciplinary team is needed in treating hospitalized diabetic foot infections. Abstract: Aims: 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 5 days to 2 days, 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.