Improving Timely Referrals by Implementing Lower Extremity Amputation Prevention Tool in an Suburban Wound Care Clinic

Abstract

Azam Tayyebi

Background: Globally, every 30 seconds there is an amputation due to a non-healing diabetic foot ulcer (DFU). Research shows prevention programs such as utilizing a Lower Extremity Amputation Prevention (LEAP) tool could reduce DFU complications.
Local Problem: Impact DuPage (2013) reported that 8.1% of the DuPage population had diabetes, however 12% of the patients with diabetes have had no diabetic foot screening [1]. At a clinic located in DuPage County, the charts audit for the second half of 2017 indicated 55% compliance with documentation of diabetic foot exams.
Method: This quality improvement (QI) used four two-weeks Plan-Do-Study-Act cycles. Each cycle included tests of change (TOC) related to patient and team engagement, DFU screening, and referral for treatment. Data were analyzed using run charts and the impact of the interventions were measured. Intervention: Staff was engaged by a kickoff in-service, daily huddles, and weekly team meetings. A modified “Team Effectiveness Diagnostic” survey measured team engagement. Foot Care for a Lifetime was used as shared decision-making tool. Clinicians assessed patients with diabetes with the LEAP checklist and utilized referral log to track appropriate referrals. Results: At the end, patient and team engagement improved to 75% and 92% respectively; also all patients with DFUs were assessed by the LEAP tool (100%) and appropriate referrals (100%) were made. Conclusion: Team engagement was essential in the success of this QI. Patient engagement in the care of their DFU was empowering to patients. The team became better engaged with patients and patients reported more involvement in their own care.

PDF