Technology


recommends daily foot screening for high- risk diabetic patients.10


The International


Working Group on the Diabetic Foot (IWGDF) goes further, advocating daily monitoring of temperature variations in at-risk feet.11


Thermography: a proactive approach Thermography offers a non-invasive, quantitative method to detect areas of stress, preclinical infections, and vascular abnormalities, all of which are undetectable by visual inspection. This technology transforms reactive care into a systematic, preventative approach that: n Minimises the incidence of ulcerations and unplanned hospital admissions.


n Reduces the burden on caregivers. n Enhances overall DFU and PI management.


Thermography facilitates efficient and effective daily screening for DFUs and PIs (and other morbidities), making it a practical and time-saving tool for care settings.


Evidence supporting thermography Numerous studies2


have demonstrated


thermography’s clinical utility: n Thermography objectively detects pre- ulcerous DFUs, pain, MSK issues, and PIs through thermal anomalies before visual symptoms manifest.


n Some 85 per cent of pre-ulcerous DFU sites can be identified by temperature anomalies,12


n One study14


preventable with early detection.13 reported 100 per cent


accuracy in predicting PIs, including their anatomical locations.


Evidence thus supports the integration of thermography into routine PI and DFU risk assessments, providing timely and reliable alerts for care teams. Thermography delivers quantitative data


for objective monitoring of temperature changes reducing subjectivity in risk assessment and wound evaluation.


Addressing health disparities Early signs of PIs and DFUs are often harder to identify in residents with darkly pigmented skin. However, thermography’s


Cost £m


Pressure Injuries Diabetic Foot Ulcers Total Cost


and 75 per cent of DFUs are


The initial investment can be offset by rapid, long-term savings


accuracy and utility are unaffected by skin tone, making it an equitable tool for clinical assessment.15


Electronic Health Records Outputs can be stored in resident electronic health records (EHRs). A baseline image helps in identifying subtle changes over time, which can be crucial for early detection of conditions like diabetic foot ulcers, pressure injuries, and deep vein thrombosis (DVT). Storing thermograms in health records ensures that all healthcare providers involved in a patient’s care have access to the same information. This continuity is essential for coordinated care, especially in settings like elderly care homes where multiple caregivers may be involved. Further, maintaining detailed health


records, including thermograms, can also help in meeting regulatory requirements and providing documentation for legal purposes if needed.


Costs of treating PIs and diabetic foot ulcers Using publicly available figures, we estimated the costs of treating care home residents with DFUs and PIs, and found it was a staggering £432 m as shown in Table 1. Care home residents therefore account


NHS


£2,800 £1,277 £4,077


Table 1 Cost of Treating Care Home Residents with PIs and DFUs 40


Care Home per cent CH £235 £197 £432


8.4 per cent 15.5 per cent 10.6 per cent


for approximately 11 per cent of the costs to the NHS for these two morbidities.


Cost of PIs Annually, approximately 700,000 individuals in the UK across various care settings, including care homes, hospitals, and community care, are affected by pressure ulcers.16


Each pressure ulcer adds


over £4,000 in additional costs to the NHS, and this equates to some £2.8 bn annually in costs treating PIs.


Utilising the NHS Pressure Ulcer Productivity Calculator,17


the average cost


of treating PIs in care home residents can be estimated at £413 per affected person per month. The average care home in the UK has 33 residents, so the average cost per home is some £1,461 per month per home. Overall, treating PIs for residents in care homes amounts to an incredible £235 m in per annum costs.


Cost of DFUs


The NHS also spends some £1,277m annually treating DFUs.18


Housley19 found that due to


a number of risk factors (see Figure 1), most people in a care home have a high risk of developing a foot ulcer. She also found that some nine per cent of care home residents with diabetes had a history of or had a current DFU. Using a similar methodology as for PIs, the annual cost of treating DFUs in care home residents can be estimated at some £1,229 per home per month, or £197 m per annum for the whole industry. The combined cost of treating PIs and DFUs in care home residents is thus approaching some £432 m per annum.


An opportunity for a multi-agency approach? Although this cost burden may primarily fall on NHS resources, the environment of care homes is optimal for implementing


www.thecarehomeenvironment.com March 2025


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