[INCLUSION OF THE RISK FOR DIABETIC FOOT IN THE HOSPITAL DISCHARGE LETTER IN ORDER TO ENHANCE PREVENTIVE MEASURES IN...

Severe foot ulceration in a diabetic patient, called "diabetic foot", is one of the most debilitating complications of diabetes mellitus resulting in huge costs, both personal and public. The best way to avoid this complication is by identifying the risk factors for diabetic foot, and taking early preventive actions. At any given time, more than 40% of hospitalized patients are diabetics, whether in departments of internal medicine or others. Every diabetic patient hospitalized in any department (Internal, Surgery, Geriatric, Rehabilitation or Psychiatric) undergoes an evaluation to determine the risk level for diabetic foot by the nursing staff (as required by the Israel Ministry of Health). Approximately 50% of hospitalized diabetics are classified as having high risk for complications from diabetic foot. This evaluation constitutes a window of opportunity for intervention in order to improve the patient's condition. Currently, the status of this evaluation does not appear on the patient's discharge form, neither in the nursing recommendations nor in the physician's instructions. This being the case, the evaluation has no practical value. Without this vital information, the community care doctor is not aware of the risks, and therefore does not take action to prevent the development of severe complications. During a recent project in which we assessed our own departmental quality, we successfully showed that we were able to increase the amount of hospital discharge forms containing the evaluation of the risk for diabetic foot, by a dramatic 23%. We intend to continue this implementation process, and to examine the response within the community in order to assure that the recommendations continue to appear on the discharge forms.