1 The Diabetic Foot Journal Vol 24 No 2 2021
Article
The innovative delivery of an expanded
foot clinic during the COVID-19 pandemic
and beyond
Tricia Tay, Samantha Haycocks, Adam Robinson and Naseer Ahmad
Citation: Tay T, Haycocks S,
Robinson A, Ahmad N (2021) The
innovative delivery of an expanded
foot clinic during the COVID-19
pandemic and beyond. The
Diabetic Foot Journal 24 (2): 1ā4
Key words
- COVID-19 pandemic
- Digital implementat ion
- Multidisciplinar y foot clinic
Article points
1. The COVID-19 pandemic saw
disruption and opportunit y
for the delivery of foot care.
2. We adapted by working
digitally and integrating
podiatry with tissue viability
and community nursing.
3. We expanded the foot
multidisciplinar y team clinic
to all lower limb wounds
and now accept referrals
āfuss-freeā, not only for foot
wounds (regardless of diabetes
status), but also leg/pressure
ulcers and lymphoedema.
4. While challenges remain,
we have achieved many of
the strategic objectives of
the National Wound Care
Strategy Programme.
Authors
Author details on page 2.
The COVID-19 pandemic, while extremely challenging, produced significant
opportunities for the rapid implementation of change. Many innovative practices
were driven by urgency and the usual barriers being lifted. Following a return to more
normal activity and evaluation, it is hopeful many of the positive advances will become
embedded. This article describes the changes that occurred in a multidisciplinary foot
clinic in Salford, Greater Manchester, and the likely future developments of the service.
As the COVID-19 pandemic swept across
the globe, many healthcare services saw a
temporary cessation of services and/or a
shift to digital consultations (Chadwick et al, 2020).
While wound care services were relatively protected
from service closure, in the a ut ho rsā foot clinic in
Salford, Greater Manchester, many of our frail, high-
risk patients could not attend appointments because
they were self-isolating. Therefore, the a ut ho rs
piloted the use of encrypted video consultation and
used th e mo bi le app WhatsApp. This allowed
a community podiatrist or nurse to visit a patient
in their home and gain a multidisciplinary team
(MDT) opinion (Figure 1) .
Patient consent was gathered before the
consultation. Th is allowed sa fe social d istancing
of staff across sites and for patients to remain at
home. These consultations involved history taking,
examination and assessment, as well as counselling
with appropriate safety-net advice ( Jaly et al, 2020).
Video augmented the consultation and enabled
a MDT assessment. Patients with chronic limb-
threatening ischaemia, severe infection or ulceration
were invited to attend in-person appointments for
potential life a nd limb preser vation interventions.
Those identif ied as āat-riskā during digital
consultations were fast-tracked into tertiary care
(Foot in Diabetes UK, 2020).
These observations were echoed in a su rvey of
podiatrists in the United States where there was a
significant increase in digita l consultations and self-
reported likelihood of using telecommunication
after the pa ndemic (Nevi lle et al, 2021). The authors
believe digital consultat ions will remain although
the software used will become more formalised.
The pandemic also saw the implementation
of an electronic wound care assessment tool ā the
Salford Digita l Wound Care Form. This replaced
paper records in our centre and was integrated with
the hospital-community electronic patient record.
The resulting closer collaboration of wound care
professionals, i.e. podiatrists, district nurses and
tissue viability nurses, enabled team members to all
use the same wound care form across community
and hospital settings. This reduced repetition
of assessments, facilitated communication and,
with the reduction of paper waste, mitig ated the
spread of infection. Within this tool, health issues,
allergies, intolerances and detailed information
regarding plans for the wound were recorded. The
assessment also included exa mination of lower-limb
pulses, Doppler ultra sound signals a nd pressure
indices. This, therefore, prevented duplic ation of
vascula r assessments and allowed faster clinical
decision-making, e.g. initiation of compression.
The assessment tool automatically c alculated
the risk scores t hat facilitated our audit (Figure
2). These scores included the Site, Ischaemia,
Neuropathy, Bacterial in fection, Area and Depth
(SINBAD) score and the Wound, Ischaemia and
