Producing meaningful KPI’s for a High Risk Foot Service — ASN Events
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Producing meaningful KPI’s for a High Risk Foot Service (#27)

Vanessa L Nube 1 , Danielle Veldhoen 2 , Lynda Molyneaux 3 , Thyra M Bolton 2 , Stephen M Twigg 2
  1. Sydney Local Health District, Camperdown, NSW, Australia
  2. Diabetes Centre High Risk Foot Service, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  3. Diabetes Centre, Royal Prince Alfred HOspital, Sydney, NSW, Australia

BACKGROUND
The Australian Diabetes Society recommends National data collection on the incidence and outcomes of diabetes-related foot complications.1 While a process for this is not in place, our High Risk Foot Service (HRFS) has developed meaningful key performance indicators (KPIs) that can be used to evaluate and improve our approach.

AIM
To demonstrate our use of KPIs at the Royal Prince Alfred Hospital Diabetes Centre HRFS, developed over 15 years of data collection and analysis.

METHOD
Review of currently reported clinical outcomes for management of Diabetic Foot Ulceration in the international literature and integration of a validated wound classification system led to development of KPIs (Figure 1) we use to evaluate and improve our clinical care and service performance.

RESULTS

Between 2007-2011, 492 patients with 1564 DFU’s attended for treatment. The healing rate of 85% with a median time to healing of 1.7 months (0.8-3.6) includes 80% of wounds treated. Of those that didn’t heal11% resulted in amputation. 20 % of the data was not included due to referral to other services, deaths and incomplete data. Wound severity reported using Texan Grading System2; 34% DFU were infected, 13% ischaemic, 20%  infected and ischaemic. Most were superficial (71%), 14% pre-ulcerous, 9% to tendon and 6% to bone. Patient age 65.4yrs (+ 13.3), diabetes duration 15.5yrs ( + 9.1-22.6),  72% male and 54.7% anglo-celtic. Time to presentation was 0.4 (0.1-1) months overall with new patients delayed to 1.0 (0.5-2.1) months. Re-ulceration (any location) was 66% with 34 % patients averaging 4.3 previous ulcers. 

CONCLUSION
Wound severity influences healing outcomes and adds meaning to reported clinical outcomes. Delayed presentation is associated with increased wound severity and reflects effectiveness of local referral pathways and previous ulceration predicts future re-ulceration. We recommend these factors be reported as KPIs which may provide a platform for future benchmarking and national data collection.

Figure 1.

High Risk Foot Service KEY PERFORMANCE INDICATORS

Primary

Secondary

Percentage healed (healing rate)

Number of patients  and Number of wounds treated

Time to healing

Ulcer severity by Texan Stage and Grade

Time to presentation ( new patients  and previous )

Re-ulceration rate

Past ulcer history

Percentage resulting in amputation and level of amputation (major v minor)

Percentage missing data and reason (death, referral, unknown)
  1. 1.Bergin SM, Alford JB, Allard BP et al: A limb lost every 3 hours: Can Australia reduce amputations in people with diabetes ? Medical Journal of Australia 197(4): 197-198, 2012
  2. 1. Armstrong DG, Lavery LA, Harkless LB: Validation of a diabetic wound classification system: the contribution of depth, infection and ischaemia to risk of amputation. Diabetes Care 21(5): 855-859, 1998.
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