High-risk foot (Diabetes and Endocrinology)

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Foot ulcer with infection and systemically unwell or febrile
    • Invasive infection or rapidly spreading cellulitis (defined by peripheral redness around the wound >2cm)
    • Acute ischaemia
    • Wet gangrene
    • Acute or suspected acute Charcot foot unless able to access a High Risk Foot clinic within 48hours.
    • Refer to local HealthPathways or local guidelines
    • For adults with diabetes, assess their risk of developing a diabetic foot problem at the following times:
      • when diabetes is diagnosed, and at least annually thereafter
      • if any foot problems arise
      • on any admission to hospital, and if there is any change in their status while they are in hospital
    • For low risk of developing diabetes-related foot disease, continue to carry out annual foot assessments, emphasise the importance of foot care, and advise they could progress to moderate or high risk, encourage review with podiatrist via Chronic Disease Management plan - Health professionals - Services Australia
    • Basic foot care advice and the importance of foot care
    • AT&SI people with diabetes are considered to be at high risk of developing foot complications until adequately assessed otherwise
    • Commence antibiotics as per therapeutic guidelines
    • Advance health directive could be considered in patients with vascular disease and end stage renal disease
    • Renal impairment increases the risk of amputation for people with diabetes who experience amputation rates 11 times that of the general population living with diabetes, which in turn is 15 times the rate in people without diabetes

    Examine both feet for evidence of the following risk factors:

    • Loss of Protective sensation – LOPS (use a 10 g monofilament as part of a foot sensory examination)
    • Limb ischaemia (see CPC on peripheral arterial disease)
    • Ulceration
    • Callus
    • Infection and/or inflammation
    • Foot Deformity
    • Gangrene
    • Active / suspected Charcot arthropathy
    • Links to telehealth referral
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Foot ulcer or pressure injury with mild to moderate infection <2cm around wound.
  • Necrosis/dry gangrene (with or without ulceration)
  • Non-infected foot ulcer.  For optimal care, a patient with an ulcer will be reviewed within 48 hours by a specialist High Risk Foot Service
  • Active or suspected acute Charcot foot

    • NB: client to present to High-Risk Foot Service / diabetes specialist service within 24 hours. If no specialist service is available, consult with a specialist service via telehealth e.g. statewide Podiatry telehealth, Referral Statewide Community Foot Care Hub or present to an emergency department.
Category 2
(appointment within 90 calendar days)
  • High Risk Foot (IWGDF Risk Stratification): Loss of protective sensation (LOPS) or Peripheral artery disease (PAD), and one or more of the following:
    • History of foot ulcer
    • A lower extremity amputation (minor or major)
  • End-stage renal disease
  • Peripheral arterial disease, peripheral neuropathy, or foot deformity in the absence of adequate community resources
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Medical history, medications (recent Antibiotics) and allergies, foot disease history e.g. previous foot ulceration or amputation
  • Details of all treatments offered and efficacy
  • Peripheral pulses, femoral/popliteal/foot, including claudication distance, rest pain, ischaemic changes
  • Bone infection suspected

3. Additional referral information Useful for processing the referral

  • Is the ulcer neuropathic or ischaemic (or both) in origin?
  • Is there active infection? Consider deep wound swab/pathology for culture, ESR, CRP, FBC
  • Is there invasive infection with spreading cellulitis around the wound?
  • Most recent HbA1c, renal function
  • Surgical history
  • Recent imaging e.g. X-Ray, MRI, Duplex
  • If suspected arterial disease, toe pressures, duplex scan etc

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 2 December 2024

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