Standardising practices improves clinical diabetic foot management: the Queensland Diabetic Foot Innovation Project, 2006-09.

OBJECTIVE: The aim of this paper is to report the clinical practice changes resulting from strategies to standardise diabetic foot clinical management in three diverse ambulatory service sites in Queensland, Australia.
METHODS: Multifaceted strategies were implemented in 2008, including: multidisciplinary teams, clinical pathways, clinical training, clinical indicators, and telehealth support. Prior to the intervention, none of the aforementioned strategies were used, except one site had a basic multidisciplinary team. A retrospective audit of consecutive patient records from July 2006 to June 2007 determined baseline clinical activity (n=101). A clinical pathway teleform was implemented as a clinical activity analyser in 2008 (n=327) and followed up in 2009 (n=406). Pre- and post-implementation data were analysed using Chi-square tests with a significance level set at P<0.05.
RESULTS: There was an improvement in surveillance of the high risk population of 34% in 2008 and 19% in 2009, and treating according to risk of 15% in 2009 (P<0.05). The documentation of all best-practice clinical activities performed improved 13-66% (P<0.03).
CONCLUSION: These findings support the use of multifaceted strategies to standardise practice and improve diabetic foot complications management in diverse ambulatory services.