A new service providing podiatry treatment for patients whilst they undergo haemodialysis, with the aim of reducing the number of lower limb amputations, has been launched at three sites within Nottinghamshire County by podiatrists working for Health Partnerships.
Recent research, jointly undertaken between renal research staff at Nottingham University Hospitals (NUH) and Alison Musgrove, advanced podiatrist for Health Partnerships, found that 20% of diabetic patients on dialysis have had a lower limb amputation, with half of those having lost at least one leg.
Many of these patients were found to have mobility problems which meant a struggle to access community podiatry services, which aim to treat foot problems and ultimately prevent amputation. Combined with the large time commitment of having dialysis 3 or 4 times a week, sometimes for up to 6 hours a day, they were finding it difficult to attend community clinics, or arrange convenient home visits, in order for them to have vital podiatry care.
Lisa Metcalf, specialist podiatrist for Health Partnerships, suggested the new model of care at an Invest 2 Lead programme, the Trust's highly regarded Leadership Development Programme. The idea attracted sponsorship from Paul Smeeton, Chief Operating Executive of Health Partnerships, and a trial began in October.
The new service is offered at Kingsmill, Lings Bar and City Hospital, in the dialysis units run by NUH.
Lisa said “This is a completely new way of working for us; providing community care on hospital premises. We've had fantastic support to get the service up and running, and the feedback from patients has been overwhelmingly positive. The cost of one lower limb amputation is estimated at £24,000. If we can prevent even one leg from being amputated, the service will be a success; the cost of providing this service at all three sites is considerably less than this, and the benefit to patients in terms of quality of life, and keeping them mobile is immeasurable”.
So far over 90 patients have used the service. Seven podiatrists from Health Partnerships have been involved, and as well as providing podiatry care, they have been working with tissue viability services, and the hospital orthotics services to try and integrate care and provide more efficient pathways for patients requiring this specialist input.
Lisa also commented 'I am so thankful and proud of the six other podiatrists who have come forward to help with this project. One podiatrist, Alicia Brierley has liaised with the orthotics team at Kingsmill to produce a direct referral pathway, meaning patients can get specialist footwear and off-loading, without needing a referral from their GP saving time for both patients and GPs and getting care provided sooner. There are also plans for the tissue viability services to talk to the podiatry team about pressure sore prevention and care, and how they can work together to reduce the incidence of pressure sores, which can in this vulnerable group unfortunately lead to amputation.
Paul Smeeton said:
“I was impressed by Lisa's patient focussed approach – she saw an opportunity to improve patients experience and their outcomes by providing additional care to patients when they were having treatment. I am looking forward to seeing the outcome of the trial.“
The podiatry team have conducted a survey with over 100 dialysis patients to gather their experiences of podiatry before the service began. One patient said of his community podiatry clinic:
"Sometimes it's hard to get an appointment because I can only go on a Tuesday or Thursday when I'm not on dialysis. It limits the appointments I can get and I have to wait a bit longer. I would definitely use a podiatrist on dialysis - a really good idea”
The trial is due to end in February, at which point the impact of the service will be reviewed, and patients will again be invited to give their views. If it is found to be effective, podiatry on the dialysis units may then become a permanent fixture!
See a short film about the new podiatry treatment service.