326 - More Specialties, Less Problems: Creating collaborative competency between Infectious Disease, Podiatry, and Pathology co-managing diabetic foot infections

Background: According to the 2016 and 2017 National Health Interview Survey, 9.7% of the US population is estimated to have diabetes mellitus (either type 1 or type 2). ¹ Among patients with diabetes, there is a 15% lifetime risk of developing a foot ulcer, making it an extremely common medical problem seen in both outpatient and inpatient settings.² In fact, Medicare spends $9-13 billion/year on diabetic foot osteomyelitis (DFO).³ Despite this high prevalence and cost, experts have not agreed on a set of diagnostic criteria for diagnosing DFO, ⁴ nor the optimal antibiotic management.⁵ For example, while traditionally diabetic foot osteomyelitis has been treated with 4-6 weeks of IV antibiotics in the United States, oral antibiotics have been shown to be effective with similar cure rates in multiple studies ^6–8, non-inferior in a Cochrane review,⁵  and are recommended in the most recent (2012) Infectious Disease Society of America (IDSA) DFO clinical practice guidelines.⁹

Methods: Representatives from ID, Podiatry, and Pathology collaborated to develop consensus on aspects of management of DFO. We created an educational session, inviting providers from all three departments to develop consensus on some of the controversial aspects of DFO. We assessed for knowledge gain by having these providers complete a pre-test survey as well as a post-test survey 2 weeks after the intervention. Table 1: Characteristics of Participants


Results: 27 providers completed both a pre and post-tests after attending the educational session. Significant improvements were observed in learners understanding of duration of antibiotic treatment and the role of oral antibiotics in certain cases of diabetic foot osteomyelitis to obviate the need for an unnecessary intravenous antibiotics and Peripherally Inserted Central Catheter (PICC) lines. Additionally, by working as an interdisciplinary group, many solvable misunderstandings were identified, and processes were adjusted to improve the quality and efficiency of care provided to these patients.Figure 1: Results of the Pre- and Post- Assessment


Conclusion: This multidisciplinary, educational session regarding management of DFO led to improved provider knowledge and collaborative competency between these three departments. Further study is being completed assessing patient outcomes before and after this intervention and will be available by IDWeek.