Diabetes Action Canada Workshop 2019 Access to Effective Care Pathways Overcoming Health and Health System Barriers Diabetic Foot Complication Pathway Ann-Marie McLaren, DCh, BSc Pod Med, MCLSc Wound Healing

Diabetic Foot Pathway -Step One screen assess refer Urgent (24 hrs) Limb threatening Emergency Room Active/Acute Urgent Chiropodist High/Immediate Risk Non-Urgent Chiropodist Low Risk Patient Education Self care, foot wear, when & where to seek help Ann-Marie McLaren May 31, 2019

Diabetic Foot Ulcer Clinic In-Patient Out-Patient Diabetic Foot Ulcer Clinic Person with infected diabetic foot ulcer presents to ED Urgent and Active Diabetic Foot Pathway -Step Two ED Physician Consults Medicine Surgery Chiropodists Chiropody Rapid Response chiropodist with pager for ED consults Medicine Team Surgery-Vascular Chiropodist Order Set & Antimicrobial Guidelines 80% wound healing outcomes Ann-Marie McLaren May 31, 2019

Person with Diabetic Foot Ulcer Complication Quality Improvement Initiative for Patients with Complex Diabetic Foot Ulcers -Step Three Person with Diabetic Foot Ulcer Complication Emergency Room In-Patient-Medicine Unit Vascular &/or Chiropody see within 72-24 hours Follow-up Plan Out Patient Clinic Supportive Care +/- Patient palliation +/- Wound palliation Non-Surgical Medical optimization +/- Angioplasty Wound management Debridement Antimicrobials Offloading Surgical Major procedure (+/- many of the non-surgical interventions) Transfer surgical floor 72hrs Followed by med consults Inpatient stats 10 years ago LOS 35 (+/- 18 days if need OR) Last year LOS 14 days Preliminary LOS with surgery 8 days Lesions learned: Develop plan that builds on existing resources-environmental scan Engage key stakeholders-your community of practice Implement a plan Assess outcomes Disposition Home Rehabilitation Other Ann-Marie McLaren May 31, 2019