Evolution of virtual multidisciplinary team (MDT) working to optimise inpatient diabetes foot care during covid-19

Aims: MDT working has been shown to improve outcomes in the management of diabetes foot disease. At the start of the covid-19 pandemic all multidisciplinary diabetic foot clinics (MDFCs) operated across Greater Glasgow & Clyde were suspended resulting in the loss of direct patient contact for this high risk patient group. In order to minimise the negative impact of service changes a virtual MDFC was created to support patients with complex diabetes foot conditions. Methods: (based on the Plan -Do -Study -Act Cycle). All specialties involved with the MDFC identified any capacity to review this patient group during the pandemic. This included diabetes, podiatry, orthotics, vascular, orthopaedic and infectious diseases services. The podiatry service continued to provide face to face care for active foot disease patients. A virtual, weekly MDT discussion was established via MS teams using electronic patient records to facilitate information sharing. The PDSA cycle was utilised to continuously improve the service. Results: Areas of practice that have evolved include: • Introduction of a secure app to photograph wounds and upload immediately to patient records • Rapid access referral to vascular outpatient clinics established, with podiatrists participating in these clinics to provide continuity of care • Generation of virtual clinic lists allowing review of cases in advance of the meeting to improve efficiency. Conclusions: MDFC working has evolved into a virtual forum to minimise the negative impact of covid, on the care of individuals with diabetes foot disease and is likely to become the future standard care model.

Guidelines for the management of diabetes services and patients during the COVID-19 pandemic.

The UK National Diabetes Inpatient COVID Response Group was formed at the end of March 2020 to support the provision of diabetes inpatient care during the COVID pandemic. It was formed in response to two emerging needs. First to ensure that basic diabetes services are secured and maintained at a time when there was a call for re-deployment to support the need for general medical expertise across secondary care services. The second was to provide simple safe diabetes guidelines for use by specialists and non-specialists treating inpatients with or suspected of COVID-19 infection. To date the group, comprising UK-based specialists in diabetes, pharmacy and psychology, have produced two sets of guidelines which will be continually revised as new evidence emerges. It is supported by Diabetes UK, the Association of British Clinical Diabetologists and NHS England.