A newly published study in the Journal of the American Podiatric Medical Association on multidisciplinary treatment of diabetic foot osteomyelitis is really strong work from the superb team at the Beth Israel Deaconess Medical Center in Boston.1 Bottom line: teamwork works worldwide.
Delegates within the institution from podiatry, pathology and infectious disease developed recommendations for and education on the diagnosis and treatment of diabetic foot osteomyelitis. A subsequent retrospective review of patients with diabetic foot osteomyelitis assessed the frequency with which providers implemented these recommendations. While the pre-intervention data gathering included 104 patients, the post-intervention cohort involved 32 patients due to the study coinciding with the COVID-19 pandemic and corresponding changes in hospital practice.
A post-intervention survey showed significant knowledge gains by providers regarding the duration and role of antibiotic treatment for diabetic foot osteomyelitis. Pathology reports with “non-categorizable” or “equivocal” findings decreased from 27 percent to 3.3 percent.
Other intriguing findings (albeit not statistically significant) included improvement in the correct definition of bone margins (74.0 versus 87.5 percent); unnecessary placement of PICC lines (18.3 versus 9.4 percent); and unnecessary prolonged antibiotic therapy (21.9 versus 5.0 percent).
The study authors also contend that adopting an interdisciplinary approach allowed for identification and resolution of misunderstandings along with the ability to adjust processes to improve care.
Podiatry, infectious disease and pathology are all vital specialties included in this study. I do feel that radiology might be a worthwhile future addition. Also, quality improvement projects such as this could have other applications within the medical world. Implementation of this idea could take place in a number of ways.
In our multidisciplinary practice, we have a weekly “dashboard” that reviews all of our inpatients on our “toe and flow” service. We have green, yellow and red designations for their length of stay based on the information that we have in the system. We discuss the patients and any necessary changes in the plan of care from there. Such an approach could also have potential benefits in discharge planning, outpatient follow-up or even pre-hospital care.
Dr. Armstrong is Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA).
1. Jhaveri VV, Sullivan C, Ward S, et al. More specialties, less problems: using collaborative competency between infectious disease, podiatry, and pathology to improve the care of patients with diabetic foot osteomyelitis. J Am Podiatr Med Assoc. 2021;20-178. doi: 10.7547/20-178. Online ahead of print.
Editor’s note: This blog originally appeared at: https://diabeticfootonline.com/2021/02/28/more-specialties-fewer-problems-how-using-collaborative-competencies-of-infectious-diseases-podiatric-surgery-and-pathology-in-teams-improve-care-of-diabetic-foot-osteomyelitis-japmafeettweets/. It is adapted with permission from the author.