Research by NHS Diabetes has shown that the most frequent cause of diabetes-related hospital admissions are conditions affecting the foot. To address this, Norfolk & Norwich University Hospitals NHS Trust felt that some infections could be safely treated at home, with once-daily intramuscular antibiotics administered by practice or district nurses, rather than in hospital.
During the first 22 months of using the protocol, of the 26 episodes treated, 14 people required no admission at all, and of the remainder, their length of stay was significantly shorter than those people who required immediate hospital admission. Over £62,000 was saved in the first 22 months by adopting this approach, which either avoided or reduced hospital admission.
There are several guidelines on the management of infection in the diabetic foot (eg, NICE CG119, 2011 and the Infectious Diseases Society of America, 2004) however no guidelines have been developed to help avoid acute hospital admissions explicitly, rather they focus on antimicrobials only.
To adapt the 2004 Infectious Diseases Society of America (IDSA) for local use to allow for an extra category to be created to reduce the number of admissions of people with infected diabetes related foot infections.
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