A referral pathway for patients attending the Emergency Department with an acute high risk foot pathology.

Ms Annie  Walsh1,3,4, Professor Hugh Dickson1,2,3,4, Doctor Serena Ayers5, Doctor Matthew  Malone1,3,4

1High Risk Foot Service, Liverpool Hospital, South West Sydney Local Health District , Sydney, Australia, 2Ambulatory Care Department, Liverpool Hospital, South Western Sydney Local Health District, Sydney , Australia , 3South West Sydney Limb Preservation and Wound Research Unit, Sydney , Australia , 4Liverpool Diabetes Research Collaborative Unit, Sydney , Australia , 5Liverpool Emergency Department, Liverpool Hospital, South Western Sydney Local Health District, Sydney , Australia

The aim of study was to develop a referral pathway for treatment and management of patients attending Liverpool hospital emergency department (ED) with an acute high risk foot pathology.


– Aid in the delivery of “the right care, in the right place, at the right time”

– Reduce the “time to assessment” in line with Emergency Department National Emergency Access Targets (NEAT).

– Reduce the number of avoidable admission

– Facilitate the transfer of “fast track” patients out of the ED for treatment in at the High Risk Foot Service (HRFS)

The Liverpool Hospital High Risk Foot Service Emergency Department Pathway was designed in conjunction with the ED staff to offer both clinical and after hours “on call” service.  The ED High Risk Foot Team developed included Podiatrists, Physicians, Vascular Surgeons, Continuum of Care Nurses and Hospital in the Home (HITH). ED staff attended education sessions about the pathway and how to access the service.

Over the 22-month period 154 patients were referred to the pathway, the main reason for referral was infection. Of the 154 patients, 86 were transferred to the HRFS with non-emergency symptoms not requiring admission. Twenty four were commenced on oral antibiotics. Twenty patients were avoidable admissions requiring IV antibiotics, HITH was initiated via the HRFS OPAT program.  Thirty three were inappropriate ED presentations and were provided with outpatient follow-ups. The mean time to assessment was 7minutes and the mean time from assessment to HRFS transfer was 10minutes. The remaining forty four were admitted under Vascular, all requiring immediate interventions. Of the 154 patients referred only 89 were previously known to the HRFS.

The ED high risk foot team aided with timely admissions when required while also facilitating ‘avoidable admissions’ and transfers out of the ED. Following its success the pathway will continue to operate and support the ED staff.


Annie is a Senior Podiatrist at the Liverpool Hospital High Risk Foot Service, specialising in the treatment and management of diabetic foot pathology. Annie is an associate researcher for the Liverpool Diabetes Research Collaborative Unit based at Ingham Institute of Applied Medical Research. Annie’s research interests include diabetic foot infection, Charcot neuropathic osteoarthropathy and the use of advance technology in the measurement of diabetic foot wounds, she is currently involved in three clinical trails at the Institute. Annie has completed her Masters in Wound Care from Monash University, Melbourne and she currently works as a unit advisor for the course. In 2017 Annie was elected as a Board Member of Wounds Australia, the peak body for wound care and management in Australia.

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