Impact of implementing an orthopaedic stream in a metropolitan tertiary high-risk foot service.

Abstract

Background:

Diabetes-related foot disease (DFD) is a leading contributor of global disability, hospitalisations, amputations, and healthcare expenditure. Despite the emphasis on limb salvage and revascularisation in many high-risk foot services (HRFS), the role of surgery to improve foot function and biomechanics in ulcer healing and recurrence is often underappreciated. This study aimed to evaluate the impact of implementing an orthopaedic stream within an established HRFS.

Methods:

The new model of care was implemented by an advanced practice orthopaedic podiatrist, and included staff training, establishment of an orthopaedic HRF clinic and ward round, collection of patient and service-related data, referral pathway development, and credentialling documents. We prospectively recruited patients with DFD who could benefit from orthopaedic consultation and/or intervention. Outcome data were compared to an existing foot and ankle orthopaedic cohort. Inferential statistics explored between-group and within-group comparisons.

Results:

Compared to the foot and ankle cohort (n = 134), the HRF cohort (n = 79) experienced less wait times for their initial consultation (178.8 versus 19.8 days) and surgical procedures (313.1 versus 133.6 days) and had fewer outpatient appointments (3.9 versus 2.4). There were no readmissions post-surgery in the HRF cohort, compared to 9 (16.7%) in the foot and ankle cohort. The AusTOMs quality of life measure showed statistically and clinically significant improvements in outcomes within the HRF cohort.

Conclusions:

The HRF orthopaedic model aligns with local and national objectives, emphasising sustainability, innovation, and patient-centred care. Overall, there were significant improvements in patient- and service-related outcomes within the HRFS.