Transcript The Ealing Experience and Vision for the Future: Dr Sanjeev Mehta,

The Ealing Experience and Vision for
the Future: Dr Sanjeev Mehta,
Consultant Diabetologist, Ealing
Hospital NHS Trust
Dr Sanjeev Mehta
Consultant in Diabetes and Endocrinology
Ealing Hospital NHS Trust
Integrated Care Organisation
11 January
London
Foot Network Meeting
Incorporating
the2017
Community Services of Brent, Ealing, and
Harrow
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Overview
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My background
Diabetic foot care in Ealing in 2010
Progress over the past 3 ¾ years
Challenges ahead
Questions
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My background
 London Graduate
 Specialist Registrar, Diabetes and Endocrinology, NW
Thames Rotation
 Locum Consultant in Diabetes and Endocrinology,
Central Middlesex Hospital, June – December 2009
 Consultant in Diabetes and Endocrinology, Ealing
Hospital, January 2010 to date
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Lower limb amputations in diabetic patients in Ealing,
2009/10
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Diabetic Foot Service – Ealing Hospital 2009/10
 Recently established diabetic foot clinic (Consultant
Diabetologist and podiatrist with input from Tissue
Viability Nurse)
 50 new referrals seen in the previous 12 months
 Vascular surgery clinic run in parallel
 Twice monthly diabetic foot Multidisciplinary Team
(MDT) meetings (Diabetologist, Interventional
Radiologist, Vascular Surgeon, Orthopaedic surgeon,
Podiatrists, Tissue Viability Nurse)
 No antibiotic guidelines in place for management of
diabetic foot infections
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Antibiotics – consensus statement
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Antibiotic guidelines
 Spring 2010 – Trust antibiotic guidelines written (by
myself and the Associate Specialist in microbiology)
 Spring 2010 – Microbiologists start attending diabetic
foot MDT meetings
 January 2011 – Locum Consultant in Infectious Diseases
appointed – starts attending diabetic foot MDT meetings
 Autumn 2011 – out-patient antibiotic service established
for patients who need long term iv antibiotics (eg for
MRSA osteomyelitis)
 January 2013 – first revision of Trust antibiotic guidelines
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Access to clinic and increasing capacity
Simple, mainly “tick-box” referral form developed
Referral by post, e-mail or fax
Early referral encouraged
Specialist registrars encouraged to come down to clinic
and see patients under my supervision
 Last year ~150 new referrals seen
 Podiatrists now do a daily clinic in the hospital –
dedicated slots available to review in-patients
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Teaching and Training
 Healthcare professionals
□ Diabetic foot MDT meetings
□ Diabetic foot clinic
□ Education courses and talks for General Practitioners and
Practice Nurses (e.g Warwick certificate in Diabetes Care)
□ E-star events
□ Hospital Grand Rounds
□ Junior Doctor (including CMT and GPVTS) teaching
□ Diabetic foot study day
 Patients
□ Structured Education Courses (eg “Right Start”)
□ Regular podiatry input and reinforcement of key messages
□ “Lets talk about diabetes” initiative
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Other initiatives
 Summer 2011 – In-patient Integrated Care Pathway
developed
 September 2011 – Focus on foot care at Diabetes Team
“Away Day”
 December 2011 – Diabetic Foot Study Day – free to all
staff in Ealing Integrated Care Organisation
 2012 – Formalisation of our Foot Protection Team
 Participation in the London Diabetic Foot Network
 Involvement in the amputation root cause analysis audit
 Involvement in the KCH Charcot PTH study
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Diabetic Foot Disease Profile
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Data available for every CCG in England
on the National Diabetes Information
Service website
www.diabetes-ndis.org
Examines the scale of inpatient care of
people with diabetes who are admitted
to hospital for a range of footcare
conditions
Data compiled from Hospital Episode
Statistics and covers episodes of hospital
care over the preceding 3 years,
including:
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Total episodes of inpatient care for
diabetic foot disease
Total nights in hospital due to
diabetic foot disease
Episodes of care when an
amputation is performed in those
with diabetes
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Diabetic Foot Disease Profile – Ealing PCT
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Diabetic Foot Disease Profile – Ealing CCG
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Diabetic Foot Disease Profile – Ealing CCG
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Diabetic foot Disease Profile – Ealing CCG
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Where are we now?
 41% reduction in amputations over 2 years since
Diabetic Foot Disease profiles first published
 Total amputations (major & minor) currently half the
average for all CCGs in England
 Major and minor amputation rates both significantly
below the average for all CCGs in England
 Episodes of care in hospital and numbers of days in
hospital for diabetic foot care significantly below the
average for all CCGs in England
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Challenges ahead
 Centralisation of vascular (and renal) services
□ Potential for fragmentation of care
□ Need for clear pathways and means of communication
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Shaping a Healthier Future
Lack of an integrated “Diabetes Budget”
Reaching and treating the most vulnerable patients
Demand management
Reducing in-patient length of stay
Prevention of hospital acquired foot ulcers
Casting
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Lessons learnt
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Try and do the basics well
Many heads are better than one!
Audit your amputations (and learn from this)
Know and use your audit / outcome data
Education, education, education!
Beware of complacency
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Acknowledgements
 All members of the multidisciplinary foot care team,
Ealing Hospital NHS Trust
 Community Podiatrists and the foot protection team,
Ealing Integrated Care Organisation
 Dr Jonathan Valabhji
 Dr Wing May Kong
 Professor Michael Edmonds
 Miss Stella Vig and the London Foot Network
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Thank you for your attention
 Questions?
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