Diabetic foot ulcer outcomes following implementation of a specialist wound care clinic

Objective: The aim of this study was to investigate whether the establishment of a wound care clinic (WCC) in a podiatry department would reduce the number of emergency department (ED) visits from patients with diabetic foot ulcers (DFUs) and improve the clinical outcomes for these patients. Method: This is a retrospective cohort study of adults who presented at at Kaiser Permanente Santa Clara (KPSCL) (California, US), with a newly diagnosed DFU in 2015–2016 (pre-WCC) and 2018–2021 (after the WCC was established). International Classification of Diseases (ICD) codes were searched to identify patients with DFUs. A total of 606 patients with comorbidities were also identified based on ICD-9/10 diagnostic codes and the Charlson Comorbidity Index, which predicts a 10-year mortality, calculated for each patient. Patient records were reviewed to determine if the patient had attended the ED, been hospitalised and/or required minor and/or major amputations during follow-up. Rates of ED visits, hospitalisation and complications related to their DFUs were analysed and compared. Results: When comparing pre-WCC to the established-WCC cohort, there was a significant reduction in hospitalisation rate from 21.1% to 9.9% (p<0.001) and a significant decrease in amputations from 28.1% to 13.7% (p<0.001). The rate of ED visits was 15.3% in the pre-WCC group versus 11.3% for the established-WCC cohort, although this difference was not statistically significant (p=0.14). Conclusion: Based on the authors' findings, the presence of podiatric wound care specialists within a podiatry department at a tertiary medical centre decreases the rate of hospitalisation and associated complications for patients with DFUs.