Changes to the review and management of patients with diabetes with foot ulcers in response to the covid-19 pandemic

Aims: covid-19 presented an unprecedented challenge in delivery of care for patients with diabetic foot ulcers (DFU). With the priority being reducing hospital attendances in this high risk cohort, rapid changes were made so that patients were reviewed in person only when essential. Methods: New referrals were first discussed with the referrer (community podiatry) and a joint decision made about whether the patient required tertiary care. Patients not requiring our intervention remained under the referrer's care, with provisions to refer back if concerned. For all other patients, new and follow-up, a telephone review and triage system was instigated where the patient was contacted by the podiatrist a week prior to their scheduled appointment. Specific questions were asked regarding their DFU, particularly about features of infection, antibiotic therapy and any concerns regarding foot disease. Patients not progressing well were offered a same day face to face review. Others had their appointment rescheduled for an appropriate future date. Results: Between 30/03/2020 and 27/04/2020, 113 patients (96 follow-up and 17 new) were reviewed. 58/96(60%) were progressing well and had their appointment rescheduled. 38/96(40%) were reviewed face to face. Among new patients 53% (9/17) were reviewed in clinic, 35%(6/17) remained under the care of community podiatry and 2 did not attend. There was also reduction in time from referral to assessment of urgent cases from 2-4 weeks to 2 days. Conclusion: This review and triage system reduced the footfall in hospital while keeping patients safe by prioritizing patients and through effective communication between stakeholders.