Diabetic footcare teams are being urged to “record and measure” clinical outcomes as part of the National Diabetes Foot Care Audit (NDFA) of England and Wales.
In an editorial published in The Diabetic Foot Journal and written by Professor William Jeffcoate and his team, the article is requesting more people take part in the audit to measure foot-related clinical outcomes.
The authors wrote: “None of us know how good we are without evidence, and the evidence we need is data relating to clinical outcome.”
The priority is for all of us to work out just how good we are, and we can’t do that unless we record and measure what we do
Each diabetic foot service is being asked to start recording how how many ulcers heal within 12 weeks, how many people with ulcers undergo a major amputation within an agreed time limit and how many people die.
The authors said: “Without such objective measures, we simply cannot know how good we are; we may be second to none, average or pretty awful. It’s not enough to know that you work hard and people say ‘thank you’ to you.
“The lack of firm data might not be a major problem if we knew that every service appeared more or less equally good. The trouble is that the available evidence from the UK (and from England, in particular) is that there is very considerable variation between different localities.”
More than 100 footcare teams are already registered to take part in the audit and information can be anonymously uploaded. Those who contribute will have access to regular summaries of their ulcer outcomes, as well as those across the whole of England and Wales.
The audit, which has been running since 2014, already has details on a total of almost 90,000 foot ulcer episodes, including some 22,000 each year from 2018-19 and 2019-20 — exceeding one third of the likely total number of new episodes.
The authors wrote: “This dataset not only gives services an indication of their own outcomes, but it has also made it possible to demonstrate statistically significant links between time to first expert assessment and ulcer severity and between both of these and healing by 12 weeks, incidence of major amputation and mortality within 6 months (NHS Digital, 2019).
“To be documenting outcomes in over one third of new cases is an impressive achievement by foot care teams across England and Wales and is by far greater than any other systematic audit in the field. Nevertheless, it is still only a minority, and this increases the risk that the overall findings may not be fully representative of the whole.
“Added to which, the numbers registered will surely be far less in the present year as a result of the COVID-19 epidemic. It is for these reasons that we need to do everything we can to make sure that more and more services become, and stay, involved.
“The priority is for all of us to work out just how good we are, and we can’t do that unless we record and measure what we do. After that we can compare clinical outcomes with others: counting and then comparing. If it is found that the service in your area appears less than good, the next job will be to work out why.”
To find out more about taking part in the audit, click here.
To read the full editorial, click here.