Implementation of Clinical Pathway in the management of patients with diabetic foot.

Introduction. Diabetes mellitus has considerable social impact for its invalidating complications and dramatic outcomes. The prevalence range of foot ulcers in diabetic patients is 4% to 10%. The aim of this paper is to clarify if Clinical Pathway can improve clinical outcomes in patients with diabetic foot ulcers. Methods. The Medline and Cinhal databases were searched for articles published between January 1997 and December 2007. Key words used were "diabetic foot", "critical pathway" e "clinical protocols". Studies which had a connection between Clinical Pathway and clinical, social and economic outcomes was considered. Results. Clinical Pathway, preventions screening, detailed anamnesis, patient and family education, multidisciplinary team, workforce and staff skills are the key areas for optimal management of diabetic foot ulcers. Moreover Clinical Pathway reduce lower limb amputations. Discussion. The analyzed literature underlines a meaningful reduction of some clinical outcomes (amputations, readmissions to 30 days and average lenghts of hospital stay). Nevertheless the studies are carried out in non comparable realities and the inclusion criteria weren't always the same. Therefore it's difficult to establish with certainty how much the use of the clinical pathway, in the different clinical environment, can influence the clinical outcomes in the diabetic foot patients. This suggests the necessity of deepest investigations in the specific sector.