Delay in referral to hot foot clinic; a root cause analysis and suggestions for service improvement

A systematic review investigating the identification, causes, and outcomes of delays in the management of chronic limb-threatening ischemia and diabetic foot ulceration

“…Six articles did not present age statistics. 26,27,31,37,51 No consistent definition of CLTI was given, with multiple validated scoring systems and criteria described.…”

“…Twenty-six articles 8,[23][24][25][26][27][28][29][31][32][33][35][36][37][38][39][41][42][43][46][47][48][49][50]52,53 presented data on the identification of delays. The definition of a delay was specified only within four articles 8,31,48,53 ; however, the definition of delay varied considerably between studies.…”

“…Median times ranged from 7 days 48 (range, 0-522 days) to 25 days 24 (range, 1-100 days). Three articles reported means of 17 days 47 (SD, 2 days), 24 days 50 (SD, 9 days), and 54 days, 26 respectively. Another two articles reported that 29% 8 and 24% 49 of patients presented with referral times of 14 days or more.…”

“…Twelve articles 8,24,26,30,34,37,38,[42][43][44]48,53 investigated the causes of delays. Six articles 8,24,38,42,43,48 identified causes related to health care factors, three articles 30,37,53 identified patient-related causes, and three described both.…”

“…Six articles 8,24,38,42,43,48 identified causes related to health care factors, three articles 30,37,53 identified patient-related causes, and three described both. 26,34,44 Patient factors. Two articles 34,37 explored the theme of poor symptom recognition by patients as a cause of delays.…”