Ms Sonja Rogasch1, Dr Sharon Hong1, Ms Cathy Loughry1, Prof Robert Fitridge2
1Central Adelaide Local Health Network, Adelaide, Australia, 2The University of Adelaide, Adelaide, Australia
Biography:
Sonja Rogasch is a senior Podiatrist and high-risk foot coordinator at the Central Adelaide Local Health network. She coordinates the largest multidisciplinary foot service in Adelaide across two sites, The Royal Adelaide, and Queen Elizabeth Hospitals. Sonja was involved in the development and implementation of the first Telehealth multi-disciplinary foot clinic in South Australia as part of the SAHMRI Diabetes Foot Consortium. She is passionate about improving access to high-risk foot services and improving models of care within health. Sonja has presented at both international and national conferences including The International Symposium of Diabetic Foot in The Hague.
Abstract:
Trans-phalangeal or minor digital amputations, are an important component to preserving limb and life. Traditionally these procedures have required acute hospitalisation, a finite resource which is increasingly overloaded. In conjunction with the Podiatry and Vascular departments, an administrative and treatment model of care was developed for select vascular surgeries. Eligibility criteria included medically stability (e.g., no systemic features of infection, toe pressure > 50 mmHg) and undergoing a digital amputation, local surgical debridement, or application of biodegradable temporizing matrix (BTM). Patients were reviewed by Podiatry in recovery, to ensure optimal offloading was implemented prior to discharge. A post operative review at 48 hours was led by a Podiatrist. Consultation with a Vascular consultant was provided if indicated. Subsequent follow up was determined at this review, either with Podiatry, Vascular surgery, or the multi-disciplinary foot clinic. Initial analysis (n = 17) found a marked reduction in the average length of stay when comparing pre (6.4 days) vs post (1.0 days) implementation of the day case model. This resulted in a six-fold cost reduction per patient compared to pre-implementation of the model (pre = $5,446; post = $851). At 3-months post operatively 85% of patients were healed. From inception in April 2022, we have now managed 75 cases through this model. The day case pathway reduces the length of stay and cost of surgical procedures and is of great benefit to the organisation and community, providing more access to acute beds, as well as personal benefits to patients.