Taking steps toward amputation prevention

Our feet.  Sometimes we’ll treat them to a massage or pedicure, but mostly we just take them for granted.

For people with diabetes or vascular disease, however, robust multidisciplinary foot care is vital for maintaining good health and a high quality of life. Without regular access to foot care, people with these chronic diseases run the risk of losing one foot — or both — to amputation.

“We are now well on our way in the Richmond Community of Care towards creating a diabetic foot care strategy that spans primary, community, residential and acute care,” said Lisa Stewart, Quality & Patient Safety, Richmond Hospital. “This strategy will include foot screenings, early intervention, and appropriate and timely foot care referrals.”

Coordinated foot care a high care priority

In late 2014, a group of Richmond Hospital surgeons and physicians identified the need for a coordinated foot-care approach for patients with diabetes and vascular disease. The goal? To prevent foot ulcers in the local diabetic population and to reduce the rate of complications by providing timely, coordinated care.

The resulting response is PrevAMP (Prevention of Amputation Multidisciplinary Program). PrevAMP will also include an engagement piece to ensure patients have the knowledge they need to play a role in their own foot health while VCH Richmond provides the back-up supports.

“Complications from not properly caring for feet can lead to major amputations and life-altering circumstances,” says Dr. Dan Kopac, vascular surgeon, Richmond Hospital. “PrevAMP will lead to better identification of patients at-risk for amputation.”

Ready, set, go…

In its early days at Richmond Hospital, a PrevAMP working group has formed around a common goal to ensure our patients with diabetes do not lose feet to preventable amputation. Project team leadership is marked by participation of three respected Richmond physicians — Drs. Dan Kopac, Dave Harris and Ric Kendall.

On December 9, the working session took place that brought together a group of 22 individuals, including physicians, surgeons, directors, managers, clinicians and educators from across the Richmond Community of Care to share knowledge and vision in the care of people with diabetic foot ulcers.

“It was exciting to get different health care professionals together,” Kopac said of the evening that included round-table discussion sessions. “The information gathered will help us develop model of care for the future.”

The early December session was well-timed as the Canadian Diabetes Association had recently released its 2015 annual report on November 30 that defined four key areas of recommended action; one of which was amputation prevention.

Not the first, but maybe the best

Richmond is not the first place to try such an approach, but it is the first place that has started its process by engaging all members of the care team in the early stages of planning. The early work has already caught to attention of other health authorities, wanting to collaborate on a larger scale to expand the potential impact of foot-care strategy.

“Everyone is hopeful we can initiate this program to the benefit of our patients,” said Kopac. “We’re hopeful we can create something here that will work across the entire Community of Care, and, perhaps, in other health authorities as well.”

Foot ulcers by-the-numbers

• 70 – 80% – the percentage of non-traumatic lower limb amputations caused by diabetes
• $70,000 – the direct cost of a diabetic foot requiring amputation
• 7 – LOS at Richmond Hospital of a diabetic foot patient requiring amputation
• 7 – LOS at Richmond Hospital of a diabetic foot patient requiring care, but not amputation
• 49 to 85% – the number of amputations that are preventable