Digital foot ulcer system pilot yields positive feedback
A new digital imaging footcare pathway which has been piloted in Southern Derbyshire has received positive patient feedback.
The Diabetic Foot Ulcer (DFU) monitoring system is a web-enabled digital wound monitoring, reporting and communication solution for healthcare professionals.
It allows people to be seen at multiple sites, with objective data shared across pathway for continued tracking of ulcer size and progress review. The system also lets staff at different sites can also simultaneously review ulcer status and offer advice on management.
There are five cameras which are currently in use across Southern Derbyshire, with two in the acute trust and three in community settings.
Once stable, people are seen in community clinics by specialist podiatrists with distant monitoring support from consultants.If necessary, rapid escalation of patients back to the multi-disciplinary team is facilitated by the availability of data and reports across all settings and integration of the system with the trust’s electronic medical record.
The pilot was developed because NICE guidelines suggest all people with diabetes and active foot ulcers are referred to the multidisciplinary diabetic foot team (MDFT) within 24 hours of the diagnosis of an ulcer. However, with more widespread awareness of these guidelines, especially following the successful Putting Feet First campaigns, the number of patients being seen in MDFT clinics is rising and many services are now struggling with capacity.
Poor patient experience
In Southern Derbyshire the MDFT foot clinic is based at the acute trust, Derby Teaching Hospitals NHS FT. The number of new referrals to this service has almost trebled over the last five to six years, while the number of follow-up appointments has doubled.
The continued rise in the number of people seen in this service was thought to be unsustainable, and was leading to a poor patient experience with long waiting times in clinic. It was because of the that a change in the organisation of the service was sought, with an emphasis on patients being seen closer to home, but without any loss of quality of service.
There are now 18 members of staff who are fully trained in the use of the system. In the first quarter (September-December 2016) 101 peoplewere seen in a community setting who would otherwise have been seen at the acute trust (Figure 5), with associated tariff cost savings for the CCG across integrated pathway. There have been no adverse events and patient feedback has been very positive.
One person said: “Being able to have my check-ups at my local clinic is great. I have less distance to travel and it makes getting to appointments much easier. The process of being scanned using Silhouette is also quick and I can see how my ulcer is progressing at each appointment.”
Another patient added: “We only live down the road from the clinic and it saves so much time for us.”
This pilot study, which was funded by the East Midlands Academic Health Science Network, has enabled accurate analysis of wound healing and sharing of images and data across care settings to be possible. It has also helped patients as they can be seen closer to home and evaluation in their progress to assess health economic impacts a new model of care.