Ms Kate Hawkins1, Ms Eliza White1, Prof Ton Tran2, Dr Darren Webb2,3,4, Dr Alicia James1,5,6, Dr Michelle Kaminski1,5,6
1Department of Podiatry, Monash Health, Melbourne,, Australia, 2Department of Orthopaedics, Monash Health, Melbourne,, Australia, 3Department of Orthopaedics, Cabrini Hospital, Melbourne,, Australia, 4Department of Orthopaedics, St John of God Hospital, Melbourne,, Australia, 5School of Primary and Allied Health Care, Monash University, Melbourne,, Australia, 6Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne,, Australia
Biography:
Michelle Kaminski is the Podiatry Research Lead at Monash Health with over 14 years of clinical and research experience in high-risk foot conditions. Michelle is also an Adjunct Lecturer at La Trobe University and an Adjunct Senior Research Fellow at Monash University. Michelle has led several large research projects in the public health and university sectors and is passionate about embedding research into clinical practice and mentoring emerging clinician-researchers. A career highlight was her involvement in developing the Australian guidelines for diabetes-related foot disease, where she served as secretary and first author of the Prevention Guideline.
Abstract:
Background:
Diabetes-related foot disease (DFD) is a leading contributor of global disability, hospitalisations, amputations, and healthcare expenditure. Despite the emphasis on limb salvage and revascularisation in many high-risk foot services (HRFS), the role of surgery to improve foot function and biomechanics in ulcer healing and recurrence is often underappreciated. This study aimed to evaluate the impact of implementing an orthopaedic stream within an established HRFS.
Methods:
The new model of care was implemented by an advanced practice orthopaedic podiatrist, and included staff training, establishment of an orthopaedic HRF clinic and ward round, collection of patient and service-related data, referral pathway development, and credentialling documents. We prospectively recruited patients with DFD who could benefit from orthopaedic consultation and/or intervention. Outcome data were compared to an existing foot and ankle orthopaedic cohort. Inferential statistics explored between-group and within-group comparisons.
Results:
Compared to the foot and ankle cohort (n = 134), the HRF cohort (n = 79) experienced less wait times for their initial consultation (178.8 versus 19.8 days) and surgical procedures (313.1 versus 133.6 days) and had fewer outpatient appointments (3.9 versus 2.4). There were no readmissions post-surgery in the HRF cohort, compared to 9 (16.7%) in the foot and ankle cohort. The AusTOMs quality of life measure showed statistically and clinically significant improvements in outcomes within the HRF cohort.
Conclusions:
The HRF orthopaedic model aligns with local and national objectives, emphasising sustainability, innovation, and patient-centred care. Overall, there were significant improvements in patient- and service-related outcomes within the HRFS.