A national quality survey of in-patient diabetic foot care calls for centralizing care and improving patient communication

Aims: To evaluate the quality of inpatient care for patients with diabetic foot ulcers (DFU) and examine the relationship between managerial awareness of quality indicators and the actual care provided, as documented in the electronic medical records (EMRs). Methods: A peer-reviewed audit of inpatient DFU care based on interviews with hospital and department management, yielding a comprehensive management score for each hospital; review of electronic medical records (EMR); and patient interviews. Data regarding facilities and personnel were collected as well. Results: Data was collected from 26 hospitals, 199 EMR and 86 patient interviews. Larger hospital size was correlated with higher comprehensive management scores (p = 0.008). Moreover, large hospitals were more likely to have dedicated DFU cohorts thus simplifying provision of multidisciplinary state-of-the-art care (p = 0.034). Committed managers were more likely to dedicate surgical sessions to DFU patients, mean (±SD) comprehensive management score of 95.9 ± 3.4 in hospitals with dedicated session vs. 79.7 ± 9.6 in those without (p < 0.001). Hospitals with committed management had better documentation and more prevalent use of correct diagnostic codes (r = 0.542), while higher dedication of head nurses of the DFU departments was significantly correlated with higher scores in inpatient care and patient education (r = 0.509, 0.826 respectively). Overall, patient communication and shared decision-making scored relatively low with only 78.8 % of the patients interviewed noting satisfaction. Conclusions: Large hospitals were more likely to deliver high-quality multidisciplinary care, pivotal to the care of DFU patients. Dedicated management teams strongly impact better delivery of care. Better communication and shared decision-making should be reinforced.