Journal article
Preliminary Experience with Conservative Sharp Wound Debridement by Nurses in the Outpatient Management of Diabetic Foot Ulcers: Safety, Efficacy, and Economic Analysis
The Iowa orthopaedic journal, Vol.40(1), pp.43-47
2020
PMCID: PMC7368523
PMID: 32742207
Appears in Diamond Open Access
Abstract
Treatment of diabetes costs the United States an estimated $245 billion annually; one-third of which is related to the treatment of diabetic foot ulcers (DFUs). We present a safe, efficacious, and economically prudent model for the outpatient treatment of uncomplicated DFUs.
77 patients (mean age = 54 years, range 31 to 83) with uncomplicated DFUs prospectively enrolled from September 2008 through February 2012. All patients received an initial sharp debridement by one of two orthopaedic foot and ankle fellowship trained surgeons. Ulcer dressings, offloading devices, and debridement procedures were standardized. Patients were evaluated every two weeks by research nurses who utilized a clinical management algorithm and performed conservative sharp wound debridement (CSWD).
Average time to clinical healing was 6.0 weeks. There were no complications of CSWD performed by nurses. The sensitivity for the timely identification of wound deterioration was 100%, specificity = 86.49%, PPV = 68.75% and NPV = 100% with an overall accuracy of 89.58%. The estimated cost savings in this model by having nurses perform CSWD was $223.26 per encounter, which, when extrapolated to national estimates, amounts to $1.56 billion to $2.49 billion in potential annual savings across six to ten-week treatment periods, respectively.
CSWD of DFUs by nurses in a vertically integrated multidisciplinary team is a safe, effective, and fiscally responsible clinical practice. This clinical model on a national scale could result in significant healthcare savings. Surgeons and other licensed independent practitioners would have more time for evaluating and treating more complex and operative patients; nurses would be practicing closer to the full extent of their education and training as allowed in most states.
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Details
- Title: Subtitle
- Preliminary Experience with Conservative Sharp Wound Debridement by Nurses in the Outpatient Management of Diabetic Foot Ulcers: Safety, Efficacy, and Economic Analysis
- Creators
- Ross A Schumer - United States Air Force Academy, COBrian L Guetschow - Orlando Regional Medical Center, Department of Emergency Medicine, Orlando, FLMarissa V Ripoli - University of Iowa, College of Nursing, Iowa City, IAPhinit Phisitkul - Tri-State Specialists, Sioux City, IASue E Gardner - University of IowaJohn E Femino - University of Iowa
- Resource Type
- Journal article
- Publication Details
- The Iowa orthopaedic journal, Vol.40(1), pp.43-47
- Publisher
- Dept. of Orthopaedics, The University of Iowa; United States
- PMID
- 32742207
- PMCID
- PMC7368523
- ISSN
- 1541-5457
- eISSN
- 1555-1377
- Language
- English
- Date published
- 2020
- Academic Unit
- Orthopedics and Rehabilitation; Nursing
- Record Identifier
- 9984303966602771
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