St. Luke’s cuts PAD amputation rate in half with heart team-led wound transition program

Saint Luke’s launched its Wound Transition Program in 2021, hiring a nurse navigator and assembling a multidisciplinary team of about 10 specialists, including interventional cardiology, vascular surgery, podiatry, endocrinology, orthopedics and wound care. The program surpassed national goals, cutting amputation rates by half in its first year, and continuing to lower them in 2023.

A key driver of success, Campbell explained, was ensuring patients received appropriate diagnostic testing and follow-up.

“We found that about 80% of patients who had a diagnostic angiography did not lose a limb,” she said. "So, we took another step back and asked what can we do in our practice to make that better?"

The program also tackled social determinants of health, a major barrier for PAD patients. Many lacked transportation, health literacy, or the financial means to access medications and wound care supplies. Nurse navigators provided weekly check-ins, coordinated appointments, arranged transportation, and helped patients access affordable medications and community resources.

Transportation alone was a game-changer. "Many patient are elderly [individuals] that live alone or they don't have family that can help transport, or they don't have the funds for transport. Most of them can't drive at that point. So, we found the biggest impact is making sure that these people are getting to the appointments, getting seen by the providers," Campbell said.

Another thing the team reinforced was that that guideline-directed medical therapy was needed at follow up and there should be real conversations about aggressive care versus palliative care and continuing the shared decision-making conversation with patients.

The team-based model also emphasized ongoing communication across specialties, with podiatrists playing a particularly critical role in identifying urgent cases and coordinating rapid referrals.

She said they created strong relationships with podiatry, orthopedics and wound care so patients could be seen quickly. This included making referrals to cardiology faster, Campbell explained.

The initiative began with a grant that funded the nurse navigator role and structured weekly multidisciplinary meetings to review cases and outcomes. Over time, it evolved into a limb preservation team that meets regularly to refine best practices and expand resources.

Campbell said the success of the program rests on three commitments: from the care team, from the health system, and from the patients themselves.

“We want to save your limb,” she said. “But the patient has to want that too. Building that relationship and shared decision-making from the start is essential.”