Conflicts of Interest Foot Care and Amputation Prevention: Vascular - PowerPoint PPT Presentation

4/8/2017 The “Toe and Flow” Team Model of Diabetic Conflicts of Interest Foot Care and Amputation Prevention: Vascular Surgery and Podiatry • NONE • Research support: • PCORI P2P Award –Improving delivery of care for patients with diabetic foot ulcers (BCM-PI) • Bayer (National CO-PI, Voyager Study, BCM) • Cesca Therapeutics (Steering Committee; BCM Site CO- Joseph L. Mills, Sr., MD PI) Professor of Surgery Chief of Vascular Surgery and Endovascular Therapy • Anges (Steering Committee; BCM Site PI) Michael E DeBakey Department of Surgery Baylor College of Medicine Houston, Texas 3 4 1

4/8/2017 Relationship of DFU, neuropathy and ischemia (PAD) to outcome Barshes et al. Diabetic Foot and Ankle 2013 2

4/8/2017 BUT: Flow is only one component • What about prevention clinics? • Routine foot care? • Foot screening? • High-risk patient monitoring? • Off-loading (shoes and surgery)? • Prophylactic/reconstructive/complex foot surgery? Components of Complete DF Care • Screening and Prevention • Gait analysis, biomechanics • Risk stratification (ADA Foot Risk Class) • Pressure reduction and offloading • Vascular assessment and revascularization • Surgical debridement, drainage complex infection • Postoperative monitoring of high risk foot • “Metabolic know” 11 3

4/8/2017 D.G. Armstrong, J.L. Mills / Wound Medicine 1 (2013) 13–14 “Toe and Flow” Philosophy Toe and Flow Process • Every consult seen by Podiatry and Vascular Surgery • WIfI staging at baseline and after every intervention • Drainable infection has highest priority • Then ischemia is addressed based on WIfI rubric • Plan for wound care, preparation, closure • Reassess, restage if healing stalls • At BCM, we are adding q 2 week review of C and S results and antbiotics prescribed with designated ID physicians (In and outpatient components) 4

4/8/2017 Harris Health System – Ben Taub Hospital Baylor St. Luke’s Hospital Vascular Surgery and Podiatry Outpatient Clinic Harris Health • No clear pathway or algorithm • Cultural shift: amputation inevitable versus often avoidable • Monthly meetings with Admin, Wound Clinic, Internal Medicine, ID, General Surgery and Vascular Surgery • WIfI staging for all DFUs in ED and soon for outpatients • Expansion of clinic to include VS 5

4/8/2017 SALSA 5-year experience 1/3 of DFU patients over 4 yrs required REVASC 64% Endo First 6

4/8/2017 Who needs a Team? You do. More importantly. Your patients do! TEAMS win games. Patient care is a team sport 26 7