Leading Better Value Care
Local vignette – Hunter New England LHD

Diabetes high risk foot services

Condition-specific clinic – a clinician's perspective

By Emma Martin

23 Apr 2021 Reading time approximately

What is important to know about your service?

An outpatient clinic for high risk foot services opened within Tamworth Hospital in July 2018. The Tamworth high risk foot clinic covers the Peel, Mehi and Tablelands clusters of the Hunter New England Local Health District (HNELHD). This includes Tamworth, Armidale, Inverell, Glen Innes, Tenterfield, Moree and Narrabri. The majority of communities are in rural locations spread across a vast geographical distance. HNELHD has one of the largest populations of Aboriginal people in NSW. The Royal Flying Doctors are used to fly patients to some sites.

What organisational model do you use?

Condition-specific clinic with a multidisciplinary team approach and telehealth.

Referral and triage
leads to
Multidisciplinary care
leads to
Footwear and orthotics
leads to
Coordination of ongoing care

What is special about the way care is delivered that is valuable for others to know?

The high risk foot clinic provides a multidisciplinary team approach. The staffing configuration includes a senior podiatrist, wound nurse practitioner, diabetes nurse educator, dietician, our wound clinical nurse specialist, orthopaedic registrar, and pedorthist and Aboriginal health practitioner.

The referral process is listed in HealthPathways and patients are triaged by a senior podiatrist within one working day.

Appointments are prioritised based on clinical judgement and a clinical priority tool that has been implemented across the local health district. There are clearly defined criteria that outlines the presenting problem and clinically appropriate wait times. Wait time for acute Charcot’s neuroarthropathy is 24-hours and acute foot ulceration is seven days.

The clinic also receives daily auto-generated reports from the emergency department flagging patients who presented with foot complications. The senior podiatrist reviews the medical records including tests and imaging, liaises with the medical team and, if appropriate, contacts the patient directly regarding a follow up appointment at the clinic.

A companion document describes options for organisational models in high risk foot services. One option is a high risk foot clinic – this vignette describes a local example.

How does it make a difference?

Patients do not need to travel to Sydney or Newcastle for ongoing care, which saves them travel and accommodation costs. It also allows for patients to be treated closer to home.

We enjoy celebrating good news with patients and providing support to those going through difficult experiences. As staff, you feel like you are making an impact on patient care. As this is a rural area you often get to follow up with patients or see them return to the service.

What tips do you have for others?

  • Building personal relationship with patients makes a meaningful impact on staff.
  • Establish a great network. Networking and education throughout the district was pivotal.
  • Complete an Aboriginal health impact statement and display artwork by local indigenous artists.

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