1. 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

2. 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

3. 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

4. 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 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