This technology-enabled model of care was developed for the more cost-effective management of patients with active diabetes foot ulcers (DFUs). It deploys a digital imaging, 3D measurement and data management system and has been adopted in South Derbyshire, straddling acute and community services. The impact of the new model is under continuous evaluation, however interim results at six months demonstrated advantages in areas such as objective DFU assessment, DFU outcomes monitoring and improved access to services.
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Silhouette is a proven digital wound assessment and non-contact 3D wound measurement system. It has the advantage of generating ulcer images and ulcer area depth, volume, percentage area reduction from baseline, with 3D wound measurement software so that healthcare professionals can objectively assess healing progress and response to treatment. As percentage healing reduction is tracked at every clinic visit it is possible to determine when the healing trajectory is static or deteriorating, allowing these patients to be prioritised and care escalated back to the acute Trust MDT clinic. The system therefore offers much more than the often used digital picture taken on a smart phone or digital camera.
The pilot project was funded by EMAHSN with a view to full roll-out. Silhouette data was integrated across the whole pathway with reports delivered electronically to GPs and uploaded into the electronic patient record (EPR) at the acute Trust. IT staff devised an interfacing strategy for integration of Silhouette with the DTHFT NHS Trust EPR system, based on HL7 messaging standard. Using the diabetes foot clinic codes we capture all previous activity and ongoing activity, without having to enter patients manually on the new system. Clinicians needed to map and work on the Silhouette notes configuration to allow the relevant data capture specific to their clinical needs: these notes are customer-configurable based on a universal wound assessment protocol. Implementation required staff training, done on a cascade ‘train the trainer’ approach. Five cameras were purchased as part of the pilot project, two deployed in the acute Trust clinic and three in community clinics. In the first six months, 220 patient appointments (7% of total) have taken place in community settings using the Silhouette system - these would otherwise have taken place at the acute Trust at a higher cost to the CCGs.
Patients liked the convenience of local settings, and staff said it greatly aided communication and was easy to use. The breakeven point to recover cost of Silhouette investment (ten-camera solution with data integration) has been achieved within six months. If a 35% shift of follow-up appointments is achieved from acute to community with Silhouette in place, then there is a potential saving per year of £205,000 (ten camera model: three in the acute Trust, seven in the community), across an integrated service.
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