High-risk foot (Diabetes and Endocrinology)

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Useful Management Information

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 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
Aboriginal and Torres Strait Islander people with diabetes are considered to be at high risk of developing foot complications until adequately assessed otherwise
Commence antibiotics as per therapeutic guidelines
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 evidence of the following risk factors:
- Neuropathy (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
- Deformity
- Gangrene
- Charcot arthropathy

Minimum Referral Criteria

Category 1	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
Category 2	Diabetic with high-risk foot* Peripheral arterial disease, peripheral neuropathy or foot deformity in the absence of adequate community resources *High-risk foot has 2 or more of the following: Peripheral Neuropathy (PN) Peripheral Arterial Disease (PAD) Foot deformity Significant foot deformity or a history of: previous lower limb amputation or previous foot ulceration
Category 3	No category 3 criteria
If your patient doesn't meet the minimum referral criteria If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service

Standard Referral Information

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

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
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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.)

Essential Referral Information

Details of all treatments offered and efficacy
Peripheral pulses, femoral/popliteal/foot

If a specific test result cannot be obtained due to access, financial, religious, cultural or consent reasons a clinical override may be requested. This reason must be clearly articulated in the body of the referral.

Additional Referral Information

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 bony infection? X-Ray 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
Depression Screening tool Phq-2
- Over the last two weeks, how often have you been bothered by any of the following problems?
  - Little interest or pleasure doing things?
  - Feeling down or hopeless?

Send Referrals To

Smart Referrals

Coming Soon

Internal Referrals

Diabetes/Endocrinology (E-Blueslips)

Fax

5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Service Availability

Facilities

Gold Coast University Hospital

Robina Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.