P-2017. A Clinical Management Algorithm Using Society for Vascular Surgery Wound, Ischemia, and Foot Infection (WIfI) Score in Emergency Departments (ED) for Lower Extremity Wounds (LEW) Improves Diagnostic Efficiency and Resource Allocation, Implications for Quality Improvement (QI)
Abstract
Abstract Background Management of diabetic and nondiabetic LEW is often associated with diagnostic uncertainty and inconsistent resource utilization. A comprehensive clinical management algorithm is challenging to develop and implement.Figure 1. Guideline for Triage of Adults with Lower Extremity Wound (LEW) Institutional clinical practice guideline developed for the evaluation and management of patients presenting to the ED with lower extremity wound implemented at the intervention hospital.Table 1. Demographic and Baseline Characteristics Methods A multidisciplinary QI group implemented institutional clinical practice guidelines for management of LEW inclusive of WIfI score (Fig. 1) to facilitate workup and determine admission status at 1 of 7 network hospitals in a large academic healthcare system. An EHR SQL report using custom SNOMED CT concept hierarchy grouper of 1217 ICD-10 codes identified triage and process metrics for 85 patients presenting to network hospital EDs for evaluation of LEW within 3 months pre- (n=41; 12 intervention, 29 control patients) and post-implementation (n=44; 18 intervention, 26 control patients), separated by 1 month washout. WIfI scores and clinical stage (1=very low risk to 4=high risk) were assigned according to published methods, based on clinical information at presentation. Process outcomes at the intervention hospital were compared to non-intervention hospitals using t-test or Fisher’s exact test.Table 2. Outcomes and Process…
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