Baseline characteristics of respondents
Responses were received from 52 surgeons (26.7%). Thirty-five vascular surgeons (67.3%) worked in tertiary metropolitan hospitals. Less than 10% of respondents worked in private sectors (5/52, 9.6%), (table 1).
The majority of respondents saw more than 100 DFD patients per year as inpatients (33/51, 64.7%) and outpatients (38/50, 72.0%). Of surgeons seeing more than 100 DRFD patients per year, three-quarters worked in metropolitan hospitals (25/33, 75.8% and 30/38., 79.0% for inpatient and outpatient respectively).
Multidisciplinary diabetes foot unit’s activities
An overview of MDFU services was displayed in table 2. Approximately three in five respondents reported availability of MDFU in their institutions (31/52, 59.6%). Most of these institutions were tertiary metropolitan hospitals (26/31, 83.9%). Four regional/rural hospitals and one secondary metropolitan hospital, all with more than 100 DFD presentations per year, had dedicated MDFU. None of the private hospitals included in this survey had a multidisciplinary service for patients with DFD.
Of those with available MDFU, all but one institution provided a multidisciplinary outpatient clinic (30/31, 96.8%). A dedicated MDFU ward round was only available in about half of the institutions (17/31, 54.8%), most of which were tertiary metropolitan hospitals (14/17, 82.4%).
There was heterogeneity in the admitting teams. Only nine MDFU (9/33, 27.3%) functioned as an independent unit with admission rights; while majority of patients with DFD requiring hospitalisation were admitted under vascular surgery (33/52, 63.5%).
Multidisciplinary diabetes foot unit’s composition
Eighteen respondents responded to further questions regarding composition of their MDFU ward round (figure 1). The key members participating in MDFU ward rounds were identified as podiatrists (17/18, 94.4%), vascular surgeons (16/18, 88.9%), infectious disease physicians (16/18, 88.9%), and endocrinologists (15/18, 83.3%). Approximately half of the units included a diabetes nurse specialist (8/18, 44.4%) to provide diabetes education, or a wound management nurse specialist (10/18, 55.6%) to optimise wound care.
Twenty-nine responses were received in terms of MDFU composition in the outpatient settings. The attendance rates of vascular surgeons, endocrinologists and podiatrists were similar to those in inpatient settings (23/29, 79.3%; 22/29, 75.9%, 27/29, 93.1% respectively); while infectious disease specialty was available in less than half of the MDFU outpatient clinics (14/29, 48.3%).
Orthopaedic surgeons were only involved in a much lesser extent (3/18, 16.7% for inpatient; 6/29, 20.7% for outpatient), whilst there was no affiliated plastic, reconstructive or general surgery services at all.
Outpatient follow-up of DFD patients
Patient follow-up varied according to the degree of intervention and whether an outpatient MDFU clinic was available in each institution (figure 2).
In institutions without MDFU service, the majority of patients were followed up by the vascular surgery service. Rates of vascular follow-up ranged from over half of the patients who did not undergo any intervention (13/20, 65%), to 100% in those requiring vascular reconstruction (20/20, 100%).
In institutions with MDFU, nearly a quarter of patients who required no intervention or minor amputation would be followed up in MDFU outpatient clinic (7/29, 24.1%). Vascular surgery clinic was still responsible for a significant proportion of these patient follow-up. Almost all patients that underwent revascularisation attended dedicated follow-up with vascular surgery (27/29, 93.1%).
Endocrinology, podiatry, and general practitioner each contributed to approximately 10% of patient follow-up after a hospital admission for DFD.