Delays in Diabetic Shoe Authorization Give Us All a Black Eye

Here’s the good news- this patient had a limb threatening diabetic foot ulcer that might be the deepest and biggest lesion I have ever treated with a total contact cast, and it healed. However, I had to keep her in the TCC while we waited for the paperwork from the orthotist to be processed through her primary care physician so that it could be approved. This process can take weeks, not to mention the time it takes for the shoes to be made.

In the meantime, during Hurricane Harvey flooding her cast caused her to slip on a wet surface. She ended up with a severe shoulder sprain and a very bruised face. It’s a miracle she was not severely injured. All because we were waiting for her shoe paperwork to be signed.

Before TCC
The Bad News
The culprit

I think we should develop a coordination of care quality measure to target this, but that would require funding and the engagement of entities committed to reducing amputation rate in diabetics. Silly me.

One comment

  1. Love your articles and the work you’re doing developing benchmarks. The length of time required to get those shoes is so frustrating making the transition from healed into shoe seem like a challenge every time. I’m working on finding an orthotist willing to fit a patient with small but active foot ulcers, so that i can coordinate follow up visits so the pt can get offloaded immediately after his/her fitting.


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