The diabetic foot service digital solution programme enables rapid escalation and de-escalation of patients with diabetic foot ulcers to and from secondary care, and increases accuracy and objectivity of assessments through use of 3D wound imaging and measuring technology and remote sharing of data.

The aim of this programme was to reduce the number of follow-up appointments taking place in hospital outpatient clinics, by enabling remote monitoring of patients’ wounds in the community.

Over the course of the intervention, an average of 19% of patient appointments for foot ulcers were delivered in the community, compared to all appointments being delivered in an acute setting prior to the intervention.

 Solutions / actions taken

The diabetic foot service digital solution programme uses an innovative, electronic wound assessment and information management system called Silhouette®. The Silhouette system comprises a digital wound camera, wound assessment software and an information database. It offers rapid and reliable electronic wound imaging, wound measurement, clinical data capture, documentation, and reporting along with health informatics capability. 

Using this approach supports:

• Increased efficiency – seeing patients in the community rather than outpatient clinics is more efficient, reducing acute care pressure and increasing patient flow
• More joined up care – improved access to clinical data and co-ordination of patient cases means multidisciplinary teams can work together more effectively
• A better patient experience – moving outpatient appointments from acute hospitals to community settings reduces frequent travel requirements and the technological solution helps patients feel more informed about their care.

Impact and outcomes from the project

Initial evaluation of the programme in Derbyshire in collaboration with University Hospitals of Derby and Burton NHS Foundation Trust and Derbyshire Community Health Services NHS Foundation Trust found:

• Prior to the intervention, the New to Follow up Appointment ratio for outpatient appointments for the service within an acute setting was 1:10 (for every one new appointment there were ten follow up appointments). This has since decreased to a ratio of 1:6 due to increased capability to deliver care in the community
• Over the course of the intervention an average of 19% of patient appointments were delivered in community relative to all appointments delivered in an acute setting in September 2016
• 72% of patients were seen within 30 minutes of their planned appointment time, compared to only 3% prior to the intervention
• 85% of patients advised that the technology increased their confidence in the care that they receive
• 71% of patients felt better informed about their foot care.

Key learnings

Several key lessons have been learned throughout delivery of the diabetic foot care service digital solution project, which will inform continuous improvement and shared best practice across the EMAHSN and future programmes and projects. These include:

• Both commissioning and provider buy in is essential in the planning phase when moving patients between the acute sector and the community to enable an agreement as to where the benefits will be realised.
• Modelling of camera usage to activity is recommended to influence deployment approaches and to maximise patient benefits.
• System integration to ensure patient record portals are in place can be time consuming – review innovation technical requirements in advance of the innovation being delivered.

Diabetic Foot Care Digital Solution resources