High Risk Podiatry Service - public patients

Purpose

This page contains information for general practitioners (GPs) on how to refer patients aged 16 years and over to the High Risk Podiatry Service at Mater Hospital Brisbane.

Scope of Service

This service provides care to adult patients with diabetes who have been diagnosed as being at "High Risk" of developing foot complications such as:

• Foot Ulceration
• Foot or lower limb amputation
• Hospitalisation due to foot complications
• Peripheral Neuropathy
• Peripheral Arterial Disease
• Foot Deformity

Mater Hospital Brisbane offers a multidisciplinary High Risk Foot service which is comprised of medical specialists from Diabetes, Vascular Surgery and Orthopaedics, along with specialised wound nurses and podiatrists. Patients are reviewed by the team to develop appropriate, individualised care plans.

How to refer

If referral for care is indicated, please list all of the General Referral Information and reason for request, and essential information as indicated below.

To refer, please fill out the Mater Adult Referral Form, available to download and embed into most major Practice Management software applications.

Referrals can be sent by:

Secure messaging	Medical Objects	HM4101000R8
	Healthlink EDI	materref
Fax	07 3163 8548

 

 

 

Emergency

If any of the following are present or suspected, phone 000 to arrange immediate transfer to the emergency department 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 >2 cm)
• Acute ischaemia
• Wet gangrene
• Acute or suspected Charcot

Scope of service

Conditions out of scope

Due to high demand we do not accept referrals for general foot and nail care patients who have been diagnosed as being "low risk" of developing diabetic foot complications which are considered appropriate for community or private podiatry services.

Essential information (referral will be declined without this)

• General referral information
• Details of all treatments offered and efficacy
• Peripheral pulses, femoral/popliteal/foot

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?
• Is there boney infection? XR if required.
• If suspected arterial disease - Doppler Ankle Brachial Pressure Index (ABPI), toe pressures, duplex scan etc
• Appropriate medical history including claudication distance, rest pain, ischaemic changes and risk factors.
• Results of depression screening (PHQ-2)
• Over the last two weeks, how often have you been bothered by any of the following problems?
  • little interest or pleasure in doing things?
  • feeling down, depressed or hopeless?

Other useful information for management (not an exhaustive list)

• 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 whilst they are in hospital
• For low risk of developing a diabetic foot problem, continue to carry out annual foot assessments, emphasise the importance of foot care, and advise they could progress to moderate or high risk
• Basic foot care advice and the importance of foot care
• ATSI people with diabetes are considered to be at high risk of developing foot complications until adequately assessed otherwise
• Commence amtibiotics as per therapeutic guidelines https://tgldcdp.tg.org.au/etgAccess 
• Off-loading https://www.sdc.qld.edu.au/courses/176
• Advance health directive could be considered in patients with vascular disease https://www.qld.gov.au/law/legal-mediation-and-justice-of-the-peace/power-of-attorney-and-making-decisions-for-others/advance-health-directive/
• Renal impairment increases the risk of amputation for people with diabetes who experience amputation rates 11 times that of the general diabetic population, which in turn is 15 times the rate in people without diabetes.

Examine both feet for the following risk factors:

• Neuropathy (use a 10 g monofilament as part of a foot sensory examination)
• Limb ischaemia
• Ulceration
• Callus
• Infection and/or inflammation
• Deformity
• Gangrene
• Charcot arthropathy

Categorisation:

Available appointments are provided to our patients based on clinical priority. A process of categoriation ensures safety and equity of access.

Category 1 – urgent Clinically recommended timeframe for initial appointment is 30 days	Category 2 - Priority Clinically recommended timeframe for initial appointment is 90 days	Category 3 - Routine Clinically recommended timeframe for initial appointment is 365 days
Refer directly to emergency 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 Charcot - A Urgent cases Foot ulcer or pressure injury with mild to moderate infection <2cm around wound. - B Necrosis/dry gangrene (with or without ulceration) - B Non-infected foot ulcer - B Key A – client to present to emergency department immediately B – client to present to diabetes specialist service within 24 hours.  If no specialist service is available, present to an emergency department	Diabetic with high-risk foot* *High-risk foot has 2 or more of the following: Peripheral Neuropathy (PN), Peripheral Arterial Disease (PAD), Foot deformity or a history of: previous amputation or previous foot ulceration	Peripheral arterial disease, peripheral neuropathy or foot deformity in the absence of adequate community resources

 

Mater Specialist team

The High Risk Foot team is a multidisciplinary team consisting of medical and health professionals from a number of specialties and fields. Access to the clinic will initially be via referral to Vascular Surgery.
Specialist
Dr Helen Barrett	Diabetes and Endocrine
Affiliated MDT team also includes access to:
	Podiatrist Orthopaedics Vascular Surgery

 

Bulk Billed Clinics

Mater Health offers patients the opportunity to attend bulk billed clinics. To provide your patients with the opportunity to attend a bulk billed clinic, please provide a named referral to one of the specialists listed above.

Contact us

If you wish to discuss a referral, including clinical criteria, or update the status of a current patient please contact our priority GP phone line on 07 3163 2200.

Current waiting Time for appointments

View up to date data on how long patients are waiting for their first appointment by specialty.

Referral Guideline Development

The Mater Referral Guidelines align with the standqardised best prqactice toos for referral to publicly funded specialist outpatient services development in Queensland through the Clinical Prioritisation Criteria project.

 

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