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has anyone out there started a High Risk Foot Clinic and can give some tips on the general criteria, polices and guidelines required? I have been set this task and want as much information as possible or perhaps a direction in which to source this.

Thanks :)

We have a number of them here in Melbourne, although I don't work in one personally. Which country are you in? There is an excellent one at the Austin Hospital, but I'd rather not post their contact details before I get a chance to ask them

The AJPM (Vol 41, Number 1 - 2007) has an article written by three Podiatrists at Royal Perth Hospital about the practicalities of establishing a Multidisciplinary Foot Ulcer Clinic. I too am interested in the background for this... we don't have funding or a directive yet. Would be very interested in any feedback from the Austin too, as they seem to have quite a good setup with consultant endocrinologist, orthopaedic surgeon and orthotists on board.

malaligned

Nothing simpler. All the standard procedures universal precautions and environmental managment etc are established and part of clinical governance. This will determine your minimal contextural environment including fixtures and fittings. Professional guidelines will also assist.

You need a clear rationale for the service wth policy for care and support. As to the function of service you need to clearly identify the stake holders and client demographic. Much of the success is determined by clear channels of communication and this will relate equally to the networks which support the referral mechanism and the supporting services which support your clients when discharged from the service.

For the purposes of audit you should give some thought to data collection, clinical research and cross discipline collaboration. Bare in mind the presence of a high risk clinic will not reduce the need for this kind of care. The better the service the more it will be used. It can take time however to build and more often than not the work slips back to routine care. Easy then to become overly committed to less priority work and the new service never quite reaches its full potential. So it is important to hold out for the service you want to create. This can result inmanagers having to defend their clinicians for appearing not to be over worked. A structured managment plan will help convey the overall aim and timescale of the service.

Routine clinical pathways are all well documented and management of critical incidents should be worked through with the team. This may be done on reflection in which case it is important to build a timetable appropriate to include training for operators and reflection sessions and peer teaching, or critical incident managment may be set within the published guidelines. Visting other centres and discussion their clinical experiences including variation will help.

Joel Gurr from Royal Perth Hospital (WA) published a paper recently relating to identify predicable factors in healing ulcers which if valid and reliable may provide a usfull guide to managed care. This is a complex subject however and far from being straight forward. If I were a clinical manager again responsible for consumable costs etc. I certainly would be interested in exploring this approach for fiscal guidelines.

All the research indicates foot health education if it is to be effective should correspond to other sources and be given with a uniform voice. This requires networking and sharing with all relevant sources. Whilst there is some excellent materials in use (from paper to compuuter) there is often a cost involved and it is important to consider budgetry requirements. Developing your own resources may sound a good idea but it is both time consuming and often no better than reinventing the wheel. It is all out there and just a question of drawing this together. To that effect you might like to employ a researcher to colate materials, as a prelude.

A common problem with many high risk services is the bottleneck created when the client goes back into community care. With the best intention in the world often there can be a clash of priority and patients problems reoccur. Hence they can become 'frequent flyers' , needing back into the high risk service. As a result many managers find it easier to retain their clients in the high risk service which prevents new referrals from benefitiing from special care.

To manage this you need to be cogniscent of the importance for community based support. Patient empowerment is one way but that needs to be driven by well organised systems which invloved the GPs, health professionals, community carers, and interest groups.

In summary setting up a high risk clinic is easy but making sure the service works needs much networking.

All the best

toeslayer

This publication may be of use (see link), it has some good simple messages about high-risk teams:

http://www.idf.org/home/index.cfm?node=1050&shfpid=80

Thanks Richard , I am in NSW Australia and will chase up the Austin Hospital clinic , sorry to be ignorant but can you tell me where it is?

Thanks also Hazel i have already started a document search so will make sure i read that one. I will let you know the outcome if you are interested?

Thankyou also Toeslayer you have made some great suggestions and I will follow through with these. When you say:

"All the standard procedures universal precautions and environmental managment etc are established and part of clinical governance"

where would they be established and how do I access them?

And finally Byron I have this book and have found it a great tool and also very inspirational , thanks for the suggestion.

>"All the standard procedures universal precautions and environmental managment etc are established and part of clinical governance"

where would they be established and how do I access them?

If you are working in public health these will all be prepublished (and a condition of service you adhere to them). If you are employed, your employer should have access to similar details. There are many guidelines available from the professional bodies and registration boards. Try the Podiatry Council webpage. Queensland Health have been very active in diabetes care but there are many many others and all post their dcumentation on the web. Have a Google

toeslayer

The Austin High Risk Foot Clinic is at the repatriation campus of the Austin Hospital in Heidelberg, Melbourne. (Not to be confused with the Austin Wound Clinic, which is something different entirely).
The High Risk clinic does have orthotists involved as well, which has proven useful for total contact casting and specialised wound offloading on a weekly basis, as well as consultation from endocrinologists and orthopods where necessary as I understand it. I suspect there are wound care nurses involved also, but my direct contact with them has been limited to the pods and P&Os. Incidentally, it's one of the best examples fo the latter two professions working in close harmony and for that alone is worth the look.

Thanks again for your replies, I believe we have a good team ready to get this up and running .I am putting it all together with a Nurse practitioner in wounds who is also passionate about the high risk foot .Thankyou for your input I will follow all these ideas up and if you think of anything else that would be great too.