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Reducing length of stay for diabetic foot osteomyelitis patients


Journal of Diabetes, Metabolic Disorders & Control
Rajiv M Mallipudi,1 Ajaypaul Singh,1 Vishnu A Shenoy,2 John Palumbo,1 Tabassum Firoz,1 Kristan Sikorski1

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Abstract

Admissions for diabetic foot osteomyelitis (DFO) are associated with increased length of stay due to several modifiable barriers and one of which includes setting up intravenous (IV) antibiotics upon discharge. The aim of this study was to reduce the length of stay (LOS) by at least 10% for all DFO patients who underwent surgical amputation and required IV antibiotics upon discharge. Using a quality improvement approach, the patient journey was mapped out using Lean principles and areas of waste were identified. An innovative electronic order was created and implemented to facilitate placement of a PICC (peripherally inserted central catheter) line to be placed immediately after podiatry surgery to reduce the length of time between surgery and PICC line placement. Pre-intervention and post-intervention LOS was compared using Mann-Whitney test to analyze the nonparametric distribution of the data. The post-intervention group had a mean LOS of 7 days (pre-intervention group: 10 days, p-value=0.027), and the length of time between podiatry surgery to placement of the PICC line was a mean of 2 days (pre-intervention:5.29 days; p-value=0.008). This study used Lean methodology to identify areas of waste, facilitate discharge and subsequently reduce the LOS for DFO surgical patients.

Keywords

length of stay, discharge planning, diabetic foot osteomyelitis, diabetic foot ulcers

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