The Elevator Pitch. The Health Roundtable

Transcription

1 The Elevator Pitch Patients experiencing both diabetes and renal failure have greater risks of lower limb amputations due to the combined effects of sustained uraemia and hyperglycaemia. In the last three years at Counties Manukau Health, 97 amputations resulted from patients with diabetes who were also receiving dialysis treatment at the time of their amputation. Foot lesions or ulcers are potentially the most preventable but also the most frequently mismanaged complication of diabetes. This collaborative focus on improving access to Podiatry services for Renal patients with diabetes by addressing issues of inequality to reduce the incidence of amputations and consequently improve patient s quality of life.

2 Poster Session HRT11420 Innovation Awards November 2014 Melbourne Feet for Life Saving limbs, saving lives Presenters: Fakaola Otuafi, Rowena Scofield Middlemore Hospital Counties Manukau District Health Board New Zealand

3 The Problem Amputations per month: 3-4 Average wait time to see podiatrist: 12 weeks Annual spend on amputations: $1+m Did not attend rates for podiatrist clinic: 12% Average length of stay: 23 days Mortality rate: High Many of these amputations are preventable!

4 The Aim To improve access to podiatry services for renal patients with diabetes in Counties Manukau, and to reduce the number of lower limb amputations of diabetic patients on dialysis by 10% by July 2014

5 Baseline Data May April 2013: Total CMH 116 lower limb amputations; 47 Renal patients Of these 47 patients, 30 have since died. (12 of these patients died within 8 weeks of amputation) These patients had a total of 112 referrals to Podiatry and the average wait time was 12 weeks Number of acute inpatient events beforeamputation: 504 Number of acute inpatient events afteramputation: 370 Actual cost of inpatient events for these 63 patients: $2,868,287.73

6 Key Changes Identification Development of form to identify patients with foot complications Patients assessed weekly Assessment and education performed at bedside with patient & family/whaanau Early identification = early intervention Taking the clinic to the patient Intervention Taking the clinic to the patient (onsite podiatrist) Patient and family/whaanau education on identification and self-management Up-skilling of renal staff in wound care

7 Outcomes So Far. DNA rate decreased from 12% to <4% from 12% to <4% Only 28 amputations this year, 30% reduction from previous yrs.

8 Cost associated with amputation can be between:$12,000 to $80,000 $720,000 $240,000 Base rate: $12, patients (wound + poor blood flow) 60 patients (complex wound) Save $960,000 not including hospitalisation/rehabilitation costs.

9 Intervention Reduce wound by 63% Offloading Debridement Cat boot Onsite footwear assessment Correct footwear

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11 Lessons Learned Feet for Life is not only reducing amputations and the impact on patients and their families Feet for Life is saving lives! The Collaborative Team: Clinical Lead: Viliami Tutone Team: Rowena Scofield, Fakaola Otuafi, Lawrence Kingi, Jubeda Shah Project Manager: Jacqueline Schmidt-Busby Improvement Advisor: Prem Kumar Acknowledgements: Shannon Wetere, Gina Wetere, Pauline Sanders-Telfer, Roger Grech, Catherine Tracey, Anthony Ng, Penny Wilkings, Frances Reid, Sally Fox and The Beyond 20,000 Days Campaign. For further information, please contact: or