Reducing major amputation in diabetic patients

The All Party Report on Vascular Disease report has shown persistently high minor and major lower extremity amputation rates  in those with diabetes in the South Western region. Preliminary NHS Diabetes Peer review visits between 2012 and 2014 also identified a number of challenges which can delay treatment of diabetic foot ulcers.

In order to gain a greater understanding of the causes of the variation in the South West, the South West Cardiovascular Strategic Clinical Network (SCN) is undertaking comprehensive peer reviews of foot care pathways and services available in all Clinical Commissioning Group (CCG) areas.  The first of these will take place at University Hospital Bristol and North Bristol Hospital Trust early in October 2014. It is our aim to complete the all the reviews by 31 March 2015 when we plan to produce a comprehensive report summarising to outcomes from across the South West.

The reviews will assess the quality and accessibility of foot care for people with diabetes in comparison with national standards. The successes and areas for improvement in each CCG area will be based on NICE guidelines CG 10 including 9 Processes of Care for diabetes, Diabetes UK State of the Nation 2013 15 standards of care and outcome, and the successful cancer, cardiovascular and stroke peer reviews already in operation. We would like the outcomes of the review to enable organisations to focus on improving care for patients and ultimately a reduction in lower limb amputations. Thus a detailed report along with recommendations will be provided on completion of each review.

As part of the review we will aim to meet with members of the multi-disciplinary team (including diabetes foot care leads in podiatry, vascular and orthopaedic surgery, diabetic medicine, and orthotics), a GP lead for diabetes and patients who are undergoing treatment of diabetic foot ulcers.

It is the aim of the SCN to support the reduction of major amputations in diabetic patients to be below the national average by March 2018. It is hoped that the diabetic foot care peer reviews will prove valuable in highlighting and sharing areas of good practice. This should identify opportunities for improvement which will ultimately lead to a reduction in the incidence of diabetic foot ulcers, and enable prompt treatment when they do occur, in order to effect healing and prevent avoidable amputations.