Multidisciplinary Diabetic Foot Clinic Initiative in A High-Volume Irish Tertiary Referral Center: A Quality Improvement Project

Introduction: Diabetic foot disease is a complex multifactorial pathology that constitutes a large burden for both patients and physicians.It's complications also places a substantial burden on the patient's family.(1) The current set up in SVUH is very encouraging to set the foundation for a multidisciplinary team (MDT) input for this challenging cohort of patients. Methodology:We aimed to set up an MDT diabetic foot clinic (DFC) utilizing the variety of disciplines available in our center.A formal email that invited the potential teams and a meeting to discuss the options available was convened.The project was met with great interest from the different team representatives.The Outpatient Antimicrobial Therapy (OPAT) clinic was chosen to incorporate the MDT DFC.This clinic is already set up for wound review and has some members from the teams needed to set up the clinic, so that with some minor adjustments it can encompass the full MDT foot care service.Results: From January 2023 to July 2023, 26 clinic sessions were held.31 patients were reviewed in the MDT DFC. 9 patients achieved complete wound healing (29%).Sixteen patients were changed to a chronic wound without a surgical intervention (52%).Three patients required minor amputation (10%).Nine patients had significant peripheral arterial disease (29%) (Mean absolute toe pressure of 36 mmHg) out of which, 6 had reconstructible options and underwent balloon angioplasty.New endocrinology referrals were sent for 6 patients (19%).Referrals were made to treating endocrinologists if the patients were found to have a poor glycemic control.Twelve new referrals were made for custom made footwear (39%). Conclusion:We believe that as an initiative, the MDT DFC is a project that is showing great potential in a large volume center as SVUH.This would encourage to expand and formalize the project.