Treatment Delay in Patients With Diabetes-Related Foot Ulcers: A Walker and Avant Concept Analysis.
Jinyan Zhou, Yihong Xu, Shanni Ding and 1 others
PMID 42517470WHAT IT FOUND
Treatment delay in diabetes-related foot ulcers means the time from noticing a foot lesion to starting guideline-based specialist care.
It can be patient delay before first contact or system delay after contact, and should not be confused with slow healing.
Key findings
01Treatment delay in diabetes-related foot ulcers is a time interval from first awareness of a foot break or ulcer to the start of guideline-concordant specialist treatment.
02The interval can be split into patient delay, from first awareness to first healthcare contact, and professional/system delay, from first contact to specialist treatment.
03Fourteen studies used a 24-hour threshold from first discovery to hospital arrival, but NICE's 24-hour standard starts after a professional foot examination, so that threshold conflates patient and professional delay.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
This is a concept analysis, not a clinical trial or outcome review, so it clarifies what treatment delay means rather than proving that reducing delay improves outcomes. The authors did not formally appraise the methodological quality of the included studies. Only English- and Chinese-language peer-reviewed original studies were included, so relevant local pathways, audits, gray literature, and other languages may have been missed. Most quantitative studies were cross-sectional or retrospective, and many were conducted in China, which limits causal inference and generalisability. Included studies used different start points, endpoints, and thresholds, and some appeared to use overlapping hospital samples, so delay prevalence and outcomes cannot be compared directly. The proposed definition is not a validated measurement instrument or quality indicator.
Declared interests
Funded by Zhejiang University and Zhejiang Province nursing and science programs; the funders had no role in design, conduct, analysis, or manuscript preparation, and the authors declare no conflicts of interest.
The easy way to misread this
Do not treat the 24-hour threshold as a universal clock from the moment a patient notices a foot lesion. The paper says the guideline referral clock starts after a professional foot examination, and the concept analysis does not validate a clinical decision tool or prove that shortening delay improves outcomes.