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St. Vincent’s University Hospital Shortlisted For Overall HSE Excellence Awards Prize

21st November 2017

On 21st November, the Acute Diabetic Foot Pathway project team at St. Vincent’s University Hospital (SVUH) were shortlisted for the overall HSE Excellence Award at this year’s awards.

The Acute Diabetic Foot Pathway is a multidisciplinary initiative developed to improve the care of patients presenting with complex diabetic foot conditions.

Three hundred projects were entered for this prestigious award, with 11 finalists selected following a rigorous selection process.

There is a worldwide increase in the incidence of diabetes.  In 2015, the International Diabetes Federation estimated a 4.3% prevalence of diabetes in Ireland (172,000) with this number projected to increase.

Foot complications account for more hospital admissions than any other long term complication of diabetes and it is the leading cause for non-traumatic lower limb amputation.   Every 20 seconds someone worldwide will lose a limb to diabetes. The 5 year survival rate post amputation is equivalent to that of bowel cancer.

In 2015, 451 diabetes-related lower limb amputations were performed with an estimated cost of €13.5 million.  Management of a further 1,948 diabetic patients admitted to hospital for foot ulceration treatment brought the total estimated cost to the HSE to over €71m.

Over the past five years there has been 50% increase in the number of patients presenting to SVUH with acute diabetic foot complications requiring urgent care.  The resulting burden on our clinical service was becoming unsustainable in terms of requirement for in-patient beds, timely access to diagnostics and multi-disciplinary care.  This led to a fragmented approach to patient care resulting in prolonged lengths of stay and a high early readmission rate.  This was the catalyst to initiate the development and implementation of the pathway.

The Acute Diabetic Foot Pathway sought to streamline existing services in a coordinated, budget-neutral, multidisciplinary team approach. An algorithm and booklet were developed from the current national guidelines (Model of Care for the Diabetic Foot, HSE, 2011) and international best practice guidelines.

The multidisciplinary team included vascular surgeons, vascular clinical nurse specialist, podiatrists, tissue viability nurse specialist, endocrinologists, infectious disease specialist, allied health professionals, radiologists and bed management.

The pathway was implemented in April 2016.  To date it has resulted in significant quality improvements and major cost savings.

There was a significant decrease (25%) in the number major lower limb amputations performed.  Hospital length of stay was reduced from 26 days to 4 days.  This resulted in a total saving of 1157 bed days in a twelve month period.  Early re-admission rates were reduced from 43% to 2% following introduction of the pathway.

A significant outcome of the pathway was the improvement in the quality and safety of patient care through the reduction of out of hour’s emergency surgery.

The commencement of the Acute Diabetic Foot Pathway has resulted in considerable savings to the hospital in excess of €1,000,000.

This initiative is now embedded practice in the hospital and continues to produce measurable quality care and cost savings.

This project along with the 10 other  projects will be presented at the Health Service Excellence Awards ceremony in Farmleigh House  in Dublin’s Phoenix Park in December 2017 where the Overall Winner will be announced along with the Popular Choice Award, the Best Team Project Award winners

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