Diabetes Foot Ulcer Service Digital Imaging & Assessment Service - community based delivery

Diabetes is a major health priority and following an East Midlands Academic Health Science Network (EMAHSN) event focused on diabetes prevention and treatment, EMAHSN launched a call for proposals seeking solutions to issues healthcare professionals and commissioners were trying to tackle.

As a result, EMAHSN is working with Entec Health Ltd and Aranz Medical Ltd to implement a new 3D wound imaging and information system called Silhouette® in order to enable routine diabetic foot ulcer (DFU) treatment to be delivered in the community rather than in the acute outpatient setting.

This is in partnership with Derby Teaching Hospitals NHS Foundation Trust, Derbyshire Community Healthcare Services NHS Foundation Trust and Derbyshire CCGs.

It is vital that all patients with DFUs receive regular treatment and check-ups. Currently these all take place in acute hospital outpatient clinics placing a severe strain on this service and requiring patients to travel substantial distances for their appointments.

There are more than 61,000 people with a DFU at any given time and 6,000 people with diabetes have leg, foot or toe amputations each year in England - many avoidable.

The project enables rapid escalation and de-escalation of patients with DFUs to and from secondary care, and increases accuracy and objectivity of assessments through use of wound imaging, measuring technology and remote sharing of data.

This will reduce the number of follow-up appointments taking place in hospitals outpatient clinics, by enabling remote monitoring of patients’ wounds in the community and improved digital health records.

EMAHSN has supported the development and delivery for this technology-enabled new model of care. Together the innovation team has successfully implemented the Silhouette® system as part of an integrated pathway across both primary and secondary care resulting in:

• Improved capacity and reduced activities / costs in secondary care resulting from reduction in outpatient referrals from 1:9 to 1:4 (average trend) - estimated at up to 2,000 follow-up appointments per year.
• Moving 35% treatment sessions to community clinics forecast to reduce overall DFU service costs by 15-20%.
• Projected savings if deployed across the East Midlands: £0.9m-£1.8m per annum

“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. We are very happy to be collaborating with EMAHSN, the community health team in Derbyshire and Entec Health in order to put this technology into practice.” - Professor Fran Game, Consultant Diabetologist, Derby Teaching Hospitals NHS Foundation Trust

“Being able to have my check-ups at my local clinic is great. I have less distance to travel and it makes getting to appointments much easier. The process of being scanned using Silhouette® is also quick and I can see how my ulcer is progressing at each appointment. I like the fact that this technology means I can get seen on my doorstep.” -  a patient