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High Risk Foot - Diabetes and Endocrinology

Emergency department referrals

Phone on call Diabetic and Endocrinology Registrar via:

  • Royal Brisbane & Women’s Hospital switch - (07) 3646 8111
  • The Prince Charles Hospital switch - (07) 3139 4000
  • Redcliffe Hospital switch – (07) 3883 7777
  • Caboolture Hospital switch – (07) 5433 8888

 

and send patient to the Department of Emergency Medicine (DEM) at their nearest hospital.

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Refer directly to emergency – Foot ulcer with infection and systemically unwell or febrile, invasive infection or rapidly spreading cellulitis (defined by peripheral redness around the wound >2cm), acute ischaemia, wet gangrene, acute or suspected Charcot – A
  • Foot ulcer or pressure injury with mild to moderate infection <2cm around wound. – B
  • Necrosis/dry gangrene (with or without ulceration) – B
  • Non-infected foot ulcer – B

 

Urgent cases – (refer to key below)

A – client to present to emergency department immediately

B – client to present to diabetes specialist service within 24 hours. If no specialist service is available, consult with a specialist service via telehealth, or present to an emergency department.

Category 2

Appointment within 90 days is desirable

  • High Risk Foot (IWGDF Risk Stratification): Loss of protective sensation (LOPS) or Peripheral artery disease (PAD), and one or more of the following:
    • History of foot ulcer
    • A lower extremity amputation (minor or major)
    • End-stage renal disease
  • Peripheral arterial disease, peripheral neuropathy, or foot deformity in the absence of adequate community resources

Category 3

Appointment within 365 days is desirable

  • No category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

  • Refer to HealthPathways for assessment and management information if available
  • For adults with diabetes, assess their risk of developing a diabetic foot problem at the following times:
    • when diabetes is diagnosed, and at least annually thereafter
    • if any foot problems arise
    • on any admission to hospital, and if there is any change in their status while they are in hospital
  • For low risk of developing a diabetic foot problem, continue to carry out annual foot assessments, emphasise the importance of foot care, and advise they could progress to moderate or high risk
  • Basic foot care advice and the importance of foot care
  • ATSI people with diabetes are considered to be at high risk of developing foot complications until adequately assessed otherwise
  • Commence antibiotics as per therapeutic guidelines  https://tgldcdp.tg.org.au/etgAccess
  • Off-loading (This is a link to CSDC eLearning courses)
  • Advance health directive could be considered in patients with vascular disease
  • Renal impairment increases the risk of amputation for people with diabetes who experience amputation rates 11 times that of the general diabetic population, which in turn is 15 times the rate in people without diabetes

Examine both feet for evidence of the following risk factors:

  • Neuropathy (use a 10 g monofilament as part of a foot sensory examination)
  • Limb ischaemia (see CPC on peripheral arterial disease)
  • Ulceration
  • Callus
  • Infection and/or inflammation
  • Deformity
  • Gangrene
  • Charcot arthropathy

Deadly Feet Program

Deadly Feet is a multi-disciplinary service providing early assessment, risk modification, and specialist intervention for Aboriginal and Torres Strait Islander people at risk of lower limb conditions associated with diabetes and/or peripheral vascular disease. Patients are reviewed by a vascular consultant, a specialist vascular sonographer, and a podiatrist within one 90 minute appointment in the Deadly Feet clinic at Redcliffe Hospital, Caboolture MATSICHS or Galangoor Duwalami Primary Healthcare Service, Hervey Bay.

Deadly Feet offers relaxed referral criteria to support equitable access to health care for Aboriginal and Torres Strait Islander people. Referrals can be made through GP Smart Referrals and no prior pathology or medical imaging are required. Alternatively referrals can be made by contacting the Deadly Feet project team by phone on 07 3647 1500 or at MNVOP@health.qld.gov.au.

Referral requirements

A referral may be rejected without the following information.

Essential Referral Information

  • General referral information
  • Details of all treatments offered and efficacy
  • Peripheral pulses, femoral/popliteal/foot

Additional Referral Information (Useful for processing the referral)

  • Is the ulcer neuropathic or ischaemic (or both) in origin?
  • Is there active infection? Consider deep wound swab/pathology for culture, ESR CRP FBC
  • Is there invasive infection with spreading cellulitis around the wound?
  • Is there bony infection? XR if required.
  • If suspected arterial disease –Doppler Ankle Brachial Pressure Index (ABPI), toe pressures, duplex scan etc
  • Appropriate medical history including claudication distance, rest pain, ischaemic changes and risk factors
  • Results of depression screening (PHQ-2)
  • Over the last 2 weeks, how often have you been bothered by any of the following problems?
    • little interest or pleasure in doing things?
    • feeling down, depressed, or hopeless?

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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