Critical pathway approach to diabetic pedal infections in a multidisciplinary setting

The purpose of this investigation was to evaluate, utilizing clinical and financial outcomes, the critical pathway approach to diabetic foot infections in an inpatient setting. All patients admitted with a primary diagnosis of a diabetic foot infection over an 18-month period from 1995 through 1996 were included in this retrospective study. Comparison is made between the podiatry-established critical pathway and nonpathway patient groups. Then comparison is made between these groups and a similar patient group from 1993 to confirm the validity of the overall results. There was a significant decrease in hospital stay and charges for pathway patients in 1995 and 1996 as compared to nonpathway patients in 1993 as well as 1995 and 1996 (p < .05). The authors also noted a significant decrease in major amputations (BKA or AKA) in pathway patients as compared to baseline values (1993 = 23%, 1995-1996 = 7%, p = .02) and as compared to patients not treated with this approach in 1995 and 1996 (pathway = 7%, nonpathway = 29%, p < .001). The data suggest that the use of a critical pathway approach allows earlier recognition, evaluation, and expedient treatment of potentially limb-threatening infections, improving patient outcomes by decreasing pedal morbidity, while encouraging judicious use of hospital resources.