Diabetes: Technology-enabled Transformation of diabetes foot service

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Case Study Summary
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Overview summary:
Diabetes is a major health challenge in the UK with a rapidly increasing number of people affected. Active disease of the foot is a crisis situation for a patient with diabetes & requires timely referral & management. A new solution for reliable & remote monitoring of diabetes foot ulcers, Silhouette, was implemented as part of an integrated primary & secondary care pathway. This initiative is supported by EMAHSN.

Who’s involved?
  • Entec Health Ltd
  • Aranz Medical Ltd
  • Derby Teaching Hospitals NHS FT
  • Derbyshire Community Healthcare Services NHS FT
Challenge identified and actions taken :
The challenge:
  • > 61,000 people with a Diabetic Foot Ulcer (DFU) at any given time
  • 6,000 people with diabetes have leg, foot or toe amputations each year in England - many avoidable
  • Improving DFU outcomes can avoid amputations, improve quality of life & mortality
  • Total NHS spending on ulceration & amputation estimated at £651m
  • 50% of foot care expenditure in diabetes is for primary, community & outpatient care
Innovation deployed:
  • Technology-enabled new model of care: 3D wound imaging & information system - Silhouette®. Enabling routine DFU treatment to be delivered in the community
  • SilhouetteStar camera uses laser-assisted 3D measurement technology to accurately map wound size, enabling clinicians to assess wound progress & response to treatment with objective data
  • Supports reliable, reproducible & remote monitoring & management of patients with active DFU & chronic complex wounds
  • The partners have collaborated to implement the Silhouette® 3D wound imaging system as part of an integrated pathway across both primary & secondary care
  • EMAHSN assisted with the procurement of the system & worked with all partners to get the new pathway implemented in four settings
  • EMAHSN is providing support with the implementation, communications, patient & public involvement, planning & procurement for wide adoption & spread
Impacts / outcomes:
Impacts to date:
  • Moving 35% treatment sessions to community clinics forecast to reduce DFU service costs by 15- 20%
  • Patient feedback very positive
  • Quality of treatment maintained with opportunities for improvements
  • Secondary applications of digital wound imaging system being explored
  • Projected savings if deployed across the East Midlands: £0.9m-£1.8m per annum

Nigel Baggaley - Podiatrist at Ripley Community Clinic

SilhouetteStar Camera

Dr Bruce Davey - CEO ARANZ Medical with SilhouetteStar Camera

Supporting quote for the innovation from key stakeholders:
Clinical Champion:
Professor Fran Game, Consultant Diabetologist, Derby Teaching Hospitals NHS Foundation Trust said; “This innovative service means patients can be seen and monitored much closer to home, outside of the often busy hospital environment. This is better for the patients and is also easing the pressure on our foot clinic at the hospital."

Service User, Patient Experience:
Albert Sutton from Kilburn said; “We only live just down the road from the clinic and it saves so much time for us, it is much closer to home than the hospital is, which means we are not spending so much time getting to and from appointments.”
Which local or national clinical or policy priorities does this innovation address:
Long term conditions: a whole system, person-centred approach
Plans for the future:
Next steps:
The project is being evaluated to confirm the health economic model and business case for spread of the innovation to other locations within and outside the East Midlands.
Tips for adoption:
  • Develop good relationships with all the key stakeholders.
  • Fully define the challenges experienced first, then consider if this is the right solution.
  • Ensure there is a clinical champion.
Contact for further information:
Achala Patel, Managing Director – achala.patel@entechealth.com
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