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Early Identification and Referral of Patients With Diabetic Foot Complications in the Emergency Department
AnChi Liu1, Eleanor Stevenson, Michael Menchine
1Author Affiliations: Department of Emergency Medicine, Los Angeles General Medical Center, Los Angeles, California (Drs Liu, and Mallett, and NP Castillo); Duke University School of Nursing, Durham, North Carolina (Drs Liu and Stevenson); and Department of Emergency Medicine, Los Angeles General Medical Center, Los Angeles, California (Dr Menchine).
Background:
Prolonged length of stay (LOS) in the emergency department (ED) and lack of post-ED follow-up pose a risk of worsening infection and amputation among patients with diabetic foot complications.
Local Problem:
Excessive ED LOS posed a risk of delayed foot care, and triage providers underutilized post-ED telehealth referrals.
Interventions:
A graphic icon on the ED dashboard, nurse-initiated order set, and staff education were implemented.
Methods:
A pre-/postimplementation design was used. Outcomes included usage of the graphic icon and order set, ED LOS, and telehealth referrals.
Results:
Use of the graphic icon and order sets significantly increased ( P < .001). The rate of telehealth referrals upon discharge also increased but was not significant ( P = .086). Interestingly, LOS increased after the intervention.
Conclusion:
Using the graphic icon and order set can streamline patient referral to telehealth care. Various factors lead to an extended LOS.
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