NICE Guidance – Lower limb PAD • NICE guidance for Lower Limb Peripheral Arterial Disease was published in August 2012 • Key priorities for implementation: • Improving information for patients and helping them to understand the progression of the disease • Offering secondary prevention of CVD in people with PAD • Smoking cessation • Diet, weight management and exercise • Lipid, diabetes and high blood pressure management • Diagnosis • Assess for presence of PAD if symptomatic, have diabetes, are having an intervention on leg • Assess and examine • Measure ankle brachial pressure • Imaging for revascularisation following duplex ultrasound • Management of intermittent claudication • Management of critical limb ischaemia • Assessed through MDT • Amputation as last resort
The All Party Parliamentary Group on Vascular Disease • Report in response to the Department of Health’s Cardiovascular Disease Outcomes Strategy • Contains key recommendations that cover prevention, diagnosis and treatment: • Prevention • Improve uptake of NHS AAA Screening Programme • Improve reporting and uptake of health checks • Improve use of vascular care plans • Awareness campaigns and early intervention, sharing best practice • Diagnosis • Improve quality and involvement of primary care in diagnosis of PAD • Improve diagnosis and treatment of diabetes • Treatment • Improve use of MDT in vascular networks • Improve and increase provisions of nurse led foot care protection teams in the community • Publish amputation rates and outcomes for transparency • Establish vascular centres of excellence that can provide 24/7 care
Key recommendations Amputation should be considered a failure Clear Pathway for all patients at risk of PVD and diabetic foot Modern technology to link centres to optimise local delivery and avoid unnecessary travelling March 2014
MDT for all PVD and DF patients Balance centralisation for complex with need to maintain equity of patient access for PVD Pathway coordinators and named contact person 24/7 Sub-24 hour referral policy for CLI to MDT QOF for referral for preventative podiatry and education
VSGBI Provision of Services 2014 – Non-Arterial Centres Recommendations • Minimum of 2 surgeons, increasing according to need and size of unit • Outpatient clinics will be main components of the service at NA sites • The role of Vascular Specialist Nurses will become increasingly important, proactive and vital clinical link for patient care within the network • Interventional radiology should continue at NA centres to improve capacity across the network • Suggested timelines for less urgent cases treated at the NA centres are: • NA diabetic foot team assessment within 24 hours (NICE guidance) • Vascular input and imaging within 48 hours (72 hours over weekends) • NA centre Endovascular Revascularisation within 10 days. • Repatriation to and from arterial centres will be key
Vascular Society – Provision of Services 2014 Recommendations cont… • The recommendations also include service provision for the following conditions: • Diabetic foot service • It is vital that diabetic foot care in the vascular network is organised to enable equal access to vascular expertise for the diabetic patient at both the arterial and non-arterial centres . • When assessment by the NA centre diabetic foot team makes a diagnosis of acute infection, without significant ischaemia, and surgical intervention to drain and debride the foot is necessary, an emergency referral should be made. • Critical limb ischaemia • Assessment, imaging, MDT and timelines for treatment • Amputations • Toe, ray and transmetatarsal amputations can be performed at the NA centre providing there is local surgical expertise.
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Overall assessment of care 34
Principal recommendations Best practice clinical care pathway to support QIF A ‘best practice’ clinical care pathway , supporting the aims of the Vascular Society’s Quality Improvement Framework for Major Amputation Surgery, and covering all aspects of the management of patients requiring amputation should be developed. This should include protocols for transfer, the development of a dedicated multidisciplinary team (MDT) for care planning of amputees and access to other medical specialists and health professionals both pre- and post operatively to reflect the standards of the Vascular Society of Great Britain and Ireland, the British Association of Chartered Physiotherapists in Amputee Rehabilitation and the British Society of Rehabilitation Medicine. It should promote greater use of dedicated vascular lists for surgery and the use of multidisciplinary records. 35
Principal recommendations Vascular review within 24 hours if admitted under another specialty When patients are admitted to hospital as an emergency with limb-threatening ischaemia, including acute diabetic foot problems, they should be assessed by a relevant consultant within 12 hours of the decision to admit or a maximum of 14 hours from the time of arrival at the hospital , in line with current guidance. If this is not a consultant vascular surgeon then one should be asked to review the patient within 24 hours of admission. 36
Principal recommendations Commence planning for rehabilitation and discharge as early as possible For patients undergoing major limb amputation, planning for rehabilitation and subsequent discharge should commence as soon as the requirement for amputation is identified. All patients should have access to a suitably qualified amputation/discharge co-ordinator . 37
Principal recommendations Surgery on planned operating lists within 48 hours As recommended in the Quality Improvement Framework for Major Amputation Surgery (VSGBI), amputations should be done on a planned operating list during normal working hours and within 48 hours of the decision to operate . Any case waiting longer than this should be the subject of local case review to identify reasons for delay and improve subsequent organisation of care . 38
Vascular services in London • London has led the reorganisation of services in the UK. • Providers and commissioners have worked together to establish vascular networks in London centred around specialist arterial vascular centres. • Most non-arterial centres have established outpatient and vascular cover rotas • There is continued increased uptake and use of the AAA screening programme • Health Checks Programme has launched and been established in London • The London Vascular Advisory Group, part of the London CVD Strategic Clinical Network has been established to support strategic improvement of vascular services for patients
London Arterial Centres • South West • North East • St George’s Hospital • Royal London Hospital • Queens Hospital, Romford • South East • St Thomas’ Hospital • North Central • Kings College Hospital* • Royal Free Hospital • University College London Hospital* • North West • St Mary’s Hospital • Northwick Park Hospital
Vascular services in London • London has led the reorganisation of services in the UK. • Providers and commissioners have worked together to establish vascular networks in London centred around specialist arterial vascular centres. • Most non-arterial centres have established outpatient and vascular cover rotas • There is continued increased uptake and use of the AAA screening programme • Health Checks Programme has launched and been established in London • The London Vascular Advisory Group, part of the London CVD Strategic Clinical Network has been established to support strategic improvement of vascular services for patients
Next steps for vascular services in London • London continues with the centralisation of vascular services. • Establishing high quality and safe services at non-arterial centres will be a continued focus • Development of services and best practice is needed for diabetic foot services, critical limb ischaemia and amputation rates • Continued development of footcare service specification is welcomed • There is a continued need for data to improve outcomes – National Diabetic Foot Audit, NCEPOD Lower Limp Amputation report, and National Vascular Registry • The London Vascular Advisory Group is looking to improve outcomes at a pan-London level: • Providing a forum for leading specialists to thrash out best practice and pathways for London • Establish a triage system for patients with a AAA in conjunction with London Ambulance Service • Improve outcomes for critical limb ischaemia in London • Respond to the recommendations of the NCEPOD Lower Limb Amputation report • Working closely with the London Foot Network to continuously improve services in the capital
Session 1 - Commissioning for Excellence Commissioning Diabetes Footcare Services in London Lesley Roberts
Commissioning Diabetes Foot Care Lesley Roberts, RGN, PGCertHSM, PGDip.Mgmt, MBA Programme Lead, Camden Diabetes IPU, Haverstock Healthcare
Camden Diabetes Integrated Practice Unit • Patient Education • Coordinated care • Minimising complications • One stop visit • Better quality of life
Why integrated care? Integrated care should be seen as a complex strategy to INNOVATE and implement LONG-LASTING CHANGE in the way services in the health and social-care sectors are delivered. European Observatory on Health Systems and Policies
What is different? • Camden Diabetes IPU began on April 2014 • Royal Free Hospitals London are accountable for a POPULATION CHANGE in outcomes • Everyone working as ONE TEAM • Everyone is patient focused. • We have agreed standards, pathways, outcomes • We use the clinical model from Diabetes Guide for London 47
Our patients developed key priorities…. • Patient Education • Coordinated care • Minimising complications • One stop visit • Better quality of life
Camden IPU Vision A service that: • Delivers outcomes that matter to patients • Works across organisational boundaries • Considers a whole population – prevent and treat • Patients leading their own care • Provides the best value for Camden taxpayers • Patient Education • Coordinated care • Minimising complications • One stop visit • Better quality of life 49
Camden Diabetes Integrated Practice Unit Implementation What will the What will the programme deliver? What is the need? programme do? Strong Clinical Services: Gaps between actual and • Review and amend : Skill mix and Staffing / Pathways / Tiers of Diabetes / Provide High Quality predicted prevalence of Clinical IT Templates / Referral Forms / Care planning / Diabetes Foot Health Integrated diabetes care, diabetes: Half of people are / Kidney disease/ Heart Disease / Eye disease. sharing data to reduce AIM: Equitable and of consistent high quality, accessible, provided undiagnosed. as close to home as possible duplication and improve communication across service. Too many people with Patient-Focused: diabetes have poorly • Structured Patient Education / Patient Involvement and Experience Improve the Health and controlled and managed AIM: Integrate around the patient / outcomes that matter to patients / wellbeing of people living with diabetes , leading to excess Easier for patients and carers to understand and navigate all diabetes in Camden. early complications and death services / Promote self-care / More structured patient education and involvement. Support the Prevention of type Inequality in care delivery and 2 diabetes, through raising Highly competent staff at all Tiers of diabetes care outcomes awareness and education. • Providing timely access to appropriately skilled healthcare professionals responsive to the individual, including those with special needs, e.g. Disjointed service have been Equitable and patient-centred housebound. commissioned : integrated • services that enable people to Build capacity and capability in primary care clinical and social care services achieve good control, thereby planned that addresses poor AIM: Increased competencies at all levels reducing complications . control of diabetes, to prevent complications Commissioned across a population Well informed, engaged patients • Working together across organisational boundaries sharing best practice, and healthcare professionals • Patient Education Diabetes services that are not delivering value, breaking down barriers and improving outcomes by committed to working in considering a whole population – prevent and treat always cost-effective . partnership to achieve best • Coordinated care AIM: Value Based Commissioning will be implemented. outcomes possible. • Minimising complications • A year on year improvement in number of undiagnosed patients with diabetes in Camden • One stop visit • Improved management of patients with uncontrolled diabetes. • Aims? Improved patient experience and quality of life • Better quality of life • Reduced mortality and morbidity from diabetes-related causes • Reduction in the numbers of unscheduled attendances and admissions to hospitals
Camden Diabetes Integrated Practice Unit (ADULTS ONLY) - Tiers of Care Version 0.6 TIER 1 TIER 2 TIER 3 TIER 4 ESSENTIAL CARE ENHANCED ESSENTIAL INTERMEDIATE CARE HOSPITAL BASED CARE Delivered by General Practices CARE Delivered by Consultant-Led Delivered by Consultant-Led in primary care, community Delivered by General Multidisciplinary team(s) in community specialist teams in secondary care settings and the patient’s • Assessment of patients newly Practices in primary care, settings • Structured Patient Education for patients home - all Practices will deliver community settings and diagnosed with Type 1 diabetes the patient’s home. • On-going management of Type 1 Tier 1 care newly diagnosed with diabetes (Type 2) • Annual review •Access to “At Risk” foot clinic • Type 1 Structured Education As Tier 1, plus: • Follow up of patients with Type 2 • Injectable therapies • Access to specialist diabetes dieticians • Review of complex/atypical patients • GLP-1 agonists • Assessment, specialist advice and • Review of patients with suspected diabetes • Medications reviews GP Practices may choose individual interventions for patients * , secondary diabetes • Complications Screening & • Management of active foot disease to deliver these services especially: • Hypo-unawareness • Assessment of Autonomic Management e.g BP, HbA1c, for their own patients only or as a ‘hub’ service • Recurrent Hypoglycaemia weight, lifestyle factors Neuropathy • Patient education (excluding • Peripheral Neuropathy • Joint clinics (e.g. Diabetes and CKD for a number of Practices. • Insulin & GLP-1 analogue initiation and Structured Patient Education on Note: There will be a /CHD / CVD clinics) • Initiation of CSII/Pump therapy diagnosis) process to identify the management for Type 2 • Telephone support for patients • Pregnancy planning & pre-conception • Assessment and management of all Tier 2 practices in • Referring appropriately to other advice clinic – in development Camden. pregnant women with diabetes • Referral to Specialist Diabetes IAPT team • Review and management of patients Tiers/specialist services • Care planning • Joint clinics where competency is known with severe and/or unstable and/or • Family planning advice and e.g CKD and Diabetes Clinic at Mary new complications of diabetes * , referral for pre-conception advice Rankin especially: • Care for housebound patients Abnormal LFTs • Same day diabetes clinic – self referral Malignant Hypertension (to avoid A&E attendance) – TO BE (including maintenance of a • Access to Clinical Psychologists register of housebound patients) DEVELOPED • Maintenance of a register of • Persistent BP>130/80 despite having 3 • Genetic causes of diabetes • Young adult clinics (18 – 25) patients with Diabetes, indicating maximum tolerated antihypertensive • Inpatient services place of care agents •Testing “at risk of diabetes” • Persistent total cholesterol>4;LDL>2 • Coordinated care patients and maintaining register despite maximum tolerated statins • Referral to IAPT • Mentoring and coaching support for Retinal Screening • Minimising complications primary care • One stop visit • Better quality of life 51
20 Objectives…. 1. The objectives of the project are as follows: 11. Review and streamline all pathways by end August 2. Identify gaps in staffing and agree additional clinical 2014. and admin staffing required and appoint staff by 12. Standardise all patient-held and staff communication March 2014. care plans by August 2014. 3. Develop outcomes by March 2014. 4. Agree minimum level of knowledge necessary for 13. Implement Diabetes Foot work-stream that ensures competency at Tier 1 level. Develop competencies in all patients are risk stratified and seen in appropriate all practices (by DSN led visits for case-note review tier of podiatry by March 2016. and management plan creation / facilitation clinics and mentoring of staff) 14. Improve diabetes care in hospital by March 2016 5. Agree, assess and improve clinical competencies for 15. Develop PIT-stop training for Tier 2 practices who can district nursing staff dealing with diabetes patients deliver a higher level of diabetes care including insulin thereby providing safer high quality care for some of and GLP-1 agonist management with 3-6 Tier 2 the most vulnerable people with diabetes by practices in place by March 2016. December 2014. 6. Develop support for District nurses: A review of 16. Implement Mental Health work-stream by January diabetes protocols/ Assessment sheets / DN care 2015. plans / Blood glucose records /creation of Aide 17. Year on year improve and standardise quality of memoir for staff /updated policy and implementation of Hypo boxes / MDT Home visits with GP and diabetes care at all Tiers by March 2016. Diabetes Specialist staff and Consultant if 18. Ensure each patient with diabetes is seen in appropriate. • Patient Education appropriate Tier of Care (or at home if housebound) 7. Deliver accredited Foundation Course in Diabetes from July 2014. by March 2016. • Coordinated care 8. Develop clinical governance arrangements across and 19. Ensure all staff dealing with diabetes patients meet between all providers by July 2014. TREND competencies by March 2016. • Minimising complications 9. For very complex and vulnerable people with 20. Promote the use of QDiabetes to Improve prevalence diabetes develop High risk MDTs in clinic settings, homes and/or practices by July 2014 to meet expected prevalence by March 2016. • One stop visit 10. Develop process to monitor outcomes by July 2014. • Better quality of life 52
Coordinated Care - Clinical Model Diabetes Guide for London Aims Tier 4 – used more appropriately Tier 3 – expanded to support primary care at Tiers 2 and 1. Tier 2 – set up Hub Commissioning Diabetic Footcare Services practices (3) Tier 1 – Better essential care in practices Patients seen in correct tier Move unobstructed through tiers • Coordinated care • Minimising complications • One stop visit http://www.londonprogrammes.nhs.uk/wp- • Better quality of life content/uploads/2011/03/Diabetes-Guide.pdf
Minimizing Complications Diabetes Foot Work-stream • Review staffing – new Band 7 Podiatrist added • Lead Diabetes podiatrist role created in Tier 3 • Improved internal referral process between podiatrists; • Different SLAs don ’ t help integration / Perverse incentives not patient focused. • Discharge back to GP • Patient Education • Standardised Care Plan etc. • Coordinated care • Foot Check Training; • Minimising complications • One stop visit • Better quality of life 54
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Minimizing Complications Diabetes Foot Work-stream • Implement Risk Stratification Tool; • Practice Nurse and District Nurse Support; - co-created training • Move appropriate patients to clinics dependent on foot risk; ongoing • Pathways; all tiers pathways now clear and patient focused. • Patient Education • Standardised Patient Leaflets; • Coordinated care • Minimising complications • One stop visit • Better quality of life 56
Minimizing Complications Diabetes Foot Work-stream • Developed Foot Protection team in Community T3; • MDT Diabetes Foot team in T4 – UCLH and RF; • QOF Foot Data reported to diabetes board; • Standardising data to deliver Outcome Metrics; • National Diabetic Foot audit 2014; • CIDR - Camden Integrated Digital record – use podiatry as exemplar • Patient Education • Coordinated care • Minimising complications • One stop visit • Better quality of life 57
QUOTES FROM GPs • “It has engaged some of the most hard to reach patients .” • “Patients who previously declined to attend appointments have been willing to attend because there was specialist input .” • “The practice will have managed to complete YOC reviews on all but one patient, and of those completed to date 100% have had all 9 care processes done .”
Have we achieved what people with diabetes want? • Patient Education • Coordinated care • Minimising complications • One stop visit • Better quality of life 59
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Session 1 - Commissioning for Excellence Panel Question and Answer Session Dr Neil Ashman Mr Obi Agu Lesley Roberts
London Diabetes Strategic Clinical Network Tea and Coffee Date Wifi Network name: CSNC1 Password: Event293
Session 1 - Commissioning for Excellence Participant Workshop Developing a Footcare Service Specification
Workshop 1 – Service Specification The London Footcare Network has been asked to develop a gold-standard footcare service specification. Questions 1. What are the key components of an integrated diabetic footcare service? – 10 min 2. What needs to be included in a service specification to ensure that an integrated service is commissioned? - 20 min 3. What components are missing from the draft service specification on your tables? – 10 min 4. Feedback - 20 min
London Diabetes Strategic Clinical Network Lunch Date Wifi Network name: CSNC1 Password: Event293
Agenda for the afternoon Session 2 – Challenges and Opportunities for Excellence 1.30pm Presentation Dr Stephen Thomas Diabetes in London Chair, Diabetes Strategic Clinical Network 1.45pm Presentation Richard Leigh Audit of Local Footcare Services in London Head of Podiatry, Royal Free Hospital 2.15pm Presentation Professor William Jeffcoate National Diabetes Footcare Audit Steering Group Chair, National Diabetes Footcare Audit 2.30pm Participant Workshop Setting local priorities Session 3 – Forward Planning 3.30pm Presentation Ms Stella Vig Feedback on the Footcare Service Vascular and General Surgeon, Croydon Hospital Specification Richard Leigh Head of Podiatry, Royal Free Hospital 4.00pm Presentation Ms Stella Vig Forward Planning and next meeting Vascular and General Surgeon, Croydon Hospital Richard Leigh Head of Podiatry, Royal Free Hospital 4.30pm Close
Session 2 - Challenges and Opportunities for Excellence Diabetes in London Dr Stephen Thomas
Dr Stephen Thomas Chair, London Diabetes Strategic Clinical Network
Population age demographics of a London borough – young population. Scale potential diabetes problem concealed.
Prevalence of chronic kidney disease in persons (18 +) 2006-2007 Mortality from chronic renal failure in persons (all ages) 2004-2006 7 www.nchod.nhs.uk
Impact of Diabetes 78
London Diabetes Strategic Clinical Leadership Group membership Name Job title Dr Stephen Thomas Consultant Diabetologist & Clinical Lead (Chair) Dr Natasha Patel Consultant Diabetologist & South London Academic Health Science Network Lead Dr Stella Vig Consultant Vascular and General Surgeon Jo Reed Diabetes Specialist Nurse (Renal) Vacant (Nurse) Miranda Greg Dietician (Diabetes) Efa Mortty Deputy Head of Medicines Management (Pharmacist) Anna Hodgkinson Pharmacist (Diabetes & CVD) Dr Samantha Mann Consultant Ophthalmologist & Retinal Screening Lead Lewisham, Southwark and Lambeth Dr Dipesh Patel Consultant diabetes & Endocrinology ABCD London Representative Dr Karen Anthony Consultant in Diabetes and Endocrinology Dr Anne Dornhorst Consultant Physician in Diabetes and Internal medicine Dr Rajashree Baburaj Consultant Physician and Endocrinologist Richard Leigh Diabetes Specialist Podiatrist & Head of Podiatry Zabeer Rashid Specialist Podiatrist - Diabetes
London Diabetes Strategic Clinical Network Applying clinical advice to commissioning to ensure value for money with excellent clinical outcomes across complex pathways and systems London Diabetes Strategic Clinical Network SCLG Clinical Director: Dr Stephen Thomas Patient Detection of Management of Education Equity of access experience diabetes care Type 1/ pumps Type 1/ pumps Patient education Patient education Patient education Primary Care 1.Unifying diagnostic Primary Care 1.Unifying diagnostic Patient education 1.Priority areas need 1.Priority areas need 1.Positive engagement 1.Positive engagement 1.Provision of courses in local 1.Ensure all GPs adhere to 1.Ensure all GPs adhere to criteria across London, criteria across London, 1.Provision of courses in local clarification between patient & clarification between patient & area 8 care processes, aiming 8 care processes, aiming not just using Health not just using Health area 2.Look at data for 2.Look at data for healthcare professionals healthcare professionals 2.Varied access to courses for DUK 15 healthcare for DUK 15 healthcare checks. checks. 2.Varied access to courses DUK/JDRF/ABCD post diagnosis DUK/JDRF/ABCD post diagnosis 3.Language/ culturally relevant essentials. essentials. 2.Scope the use of 2.Scope the use of 3.Language/ culturally relevant November ’12 Audit (21 November ’12 Audit (21 Patient experience Patient experience education HbA1c as diagnostic HbA1c as diagnostic education centres) centres) 1.Scope patient 1.Scope patient 4.Flexibility in types of Foot care Foot care tool, potentially make tool, potentially make 4.Flexibility in types of Foot Care preference for accessing Foot Care preference for accessing education on offer 1.a) Develop Foot 1.a) Develop Foot recommendations recommendations education on offer 1.Clarify organisation of 1.Clarify organisation of services services Protection Protection vascular services in Hub vascular services in Hub Healthcare professional Teams/Protocols. Teams/Protocols. Healthcare professional & Spoke models. & Spoke models. education 2.b) Rapid access foot care 2.b) Rapid access foot care education 2.Mortality from PAD 2.Mortality from PAD 1.Guidance on standardised clinics. clinics. 1.Guidance on standardised intervention is low but intervention is low but skills/ education programs skills/ education programs post-op mortality is high post-op mortality is high 2.Access to training 2.Access to training due to complications/ due to complications/ 3.Link with LETB to have 3.Link with LETB to have comorbidities. comorbidities. diabetes as part of diabetes as part of 3.Develop Foot Protection 3.Develop Foot Protection curriculum. curriculum. Teams/ protocols Teams/ protocols 4.Co-ordination between 4.Co-ordination between Community champions Community champions renal dialysis units and renal dialysis units and 1.Role and influence of 1.Role and influence of foot teams. foot teams. community champion needs community champion needs clarifying. clarifying.
Priority areas • Detection of Diabetes • Management of care • Foot care • Insulin pumps • Education • Patient Experience • Type 1 diabetes and eating disorders • DESP Reprocurement • Diabetes Prevention Programme
London Diabetes Strategic Clinical Network: Improving patient outcomes
Detection of Diabetes • 20 of 32 CCGs currently use HbA1c • Recommending the use of HbA1c across London • Aim is to pick up more people with type 2 and ‘at high risk of diabetes’ • Decision tree with advice to start intensive lifestyle interventions to reduce risk of developing diabetes and related complications.
Diabetes Prevention Programme • London SCN currently seeking to partnership with London AHSNs and interested CCGs to get involved in the national programme. • Imperial AHSN have evaluated the Westminster MyAction programme • Health Innovation Network wrote Patient Education Toolkit with SCN • Aiming to build on current programmes running locally in CCGs.
Dialysis
Case 5 • Mr TS Latin American origin • Diagnosed with T2DM in 2002 at the age of 41 years • Seen for the first time in our clinic in 2009 aged 48 years • Diabetic retinopathy and neuropathy • BP 166/97 mmHg poor compliance with ACE-I and amlodipine • Proteinuria, eGFR 86 ml/min BMI 27.1 kg/m 2
Proteinuria eGFR (MDRD) 6.3 113 5. eGFR ml/min 86 81 71 57 90 4.2 5. 4. g/24hrs 3.6 68 3.8 2.6 36 38 31 45 2.5 8 8 23 1.3 0 Renal 0. Biopsy 2009 2010 2011 2012 2014 2009 2010 2010 2011 2012
Education • Patient education • Toolkit has been downloaded far and wide. • Available at the Health Innovation Network • Healthcare Professionals education: • Currently looking at: ‘Essential skills and competencies’, ‘programmes currently available’ and ‘Continuing Education’
Session 2 - Challenges and Opportunities for Excellence Audit of Local Footcare Services In London Richard Leigh
London Diabetic Foot Audit 2015 Acute Services survey results London Footcare Network Meeting NHS England - London Strategic Clinical Networks Thursday, 5 March 2015 Acute Survey 2015
https://www.surveymonkey.com/r/acutefootcare
7 Responses In 2013 Survey 18 Responses: • Queen Elizabeth • Central Middlesex Hospital • Charring Cross Hospital Hospital • Croydon University Hospital • Hillingdon Hospital • King’s College Hospital • Homerton Hospital • King George Hospital • Mile End Hospital • Kings College Hospital • Lewisham Hospital • Homerton Hospital • Mile End Hospital • Newham University Hospital • • Croydon University North Middlesex Hospital • Northwick Park Hospital • Hospital Queens Hospital • Royal Free Hospital • • University Hospital Royal London Hospital • St Helier Hospital • West Middlesex University Hospital Lewisham • Whipps Cross University Hospital • Royal Free Hospital
Number of podiatry chairs on site 3 2 1 0 1 2 3 4 5 6 7 8 Number of Chairs Acute Survey 2015
When does podiatry operate Mon – Fri? 6 5 4 3 2 1 0 All day 4 mornings, 1 afternoon 4 all day, 1 afternoon Acute Survey 2015
Who provides podiatry 4 3 2 1 0 In house Community Both Acute Survey 2015
WTE of service 7 6 6 5 4 3 3 2 2 2 1 1 1 1 1 1 0 0 0 0 Podiatrist Podiatrist Podiatrist Podiatrist Podiatrist Diabetes Nurse Band Nurse Band Nurse Band Nurse Band HCA Admin Band 8b Band 8a Band 7 Band 6 Band 5 Nurse 8a 7 6 5 Support Specialists Acute Survey 2015
Is there 24/7 cover for acute diabetic foot? 3 Yes No 4 Acute Survey 2015
Is the 24/7 cover provided by A&E? 1 Yes No 6 Acute Survey 2015
Is there a dedicated multidisciplinary foot care service provided? 2 Yes No 5 Acute Survey 2015
Is there a pathway from A&E to the foot care MDT? 1 Yes No 6 Acute Survey 2015
Are all hospital in-patients with an active foot ulcer discharged back to the MDT? 2 Yes No 5 Acute Survey 2015
What staff are involved during scheduled 'clinics/meetings' of the MDT? 8 7 7 7 6 5 5 4 3 3 2 2 1 1 1 1 1 1 1 0 Podiatrist Diabetoligist Orthapeadic Plastic Vascular TVN Diabetes Radiologist Vascular Renal Infectious Surgeon Surgeon Surgeon Nurse Nurse Physicians Disease Specialist Specialist Acute Survey 2015
What other health care professionals are available other than in the MDT 8 7 7 6 5 5 5 4 4 3 3 3 3 3 2 1 1 1 1 0 Acute Survey 2015
What tests and results do podiatry have direct access to? 8 7 7 7 6 6 6 5 5 4 3 2 1 0 Blood tests Radiology Microbiology Duplex Histology Acute Survey 2015
Is there a dedicated clinical session for the treatment of painful neuropathy? 1 Yes No 6 Acute Survey 2015
What proportion of patients with the following conditions, are seen by vascular services within the following time frames? 5 4 Number of sites 3 25% 50% 2 75% 100% 1 0 Acute Survey 2015
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