Preventive Foot Care May Reduce Amputations and Hospitalization in ESRD

At the 2015 BC Kidney Days, Dr. Shaoyee Yao and Sarah Lacroix present the preliminary results from a quality improvement project designed to reduce preventable complications from lower extremity wounds in patients on dialysis.

It has been know for some time that foot wounds are very common in patients on hemodialysis and peritoneal dialysis, affecting up to 30-40% patients.

In addition, lower limb disease is associated with an increase risk of death, with 5 year survival decreasing from 46% in those without lower limb disease, to 23% in those with disease.

The Fraser Health Renal program designed a CQI project to establish a multidisciplinary approach to early detection and treatment of lower limb lesions in patients with ESRD.

This project was funded via our discretionary fund for just these type of projects, in addition to funding from Amgen Canada.

We elected to roll out the pilot at the Abbotsford Regional Hospital (ARH) and compare outcomes in 2 ways.  We performed an observational analysis of patients outcomes, comparing outcomes at the same site the year prior to the intervention vs the year during the intervention.  Given some concerns over a possible Hawthorne effect or that foot care might have just improved due to general medical progress, we also elected to compared outcomes at control sites that were only offering routine foot care (Surrey Memorial Hospital and Royal Columbian Hospital).

Have a look at the slide deck included below