1083 Evaluating Adherence to Best Practice for Tissue Sampling in Diabetic Foot Surgery: A Quality-Improvement Study
D Proctor, J Shea, S Lewis, T Howard, M Ahmad, O Obuh, J Shalhoub- Surgery
Abstract
Aim
To evaluate adherence to national guidelines (National Institute for Health and Care Excellence – NICE) in tissue sampling during diabetic foot surgery, and to assess the clinical course of minor diabetic foot amputations in relation to bone microbiology and antibiotic therapy.
Method
Between 2020 and 2022, three separate cycles of a plan-do-study-act (PSDA) audit were completed to evaluate the efficacy of a teaching programme and an online operation note proforma. Data were collected retrospectively with the primary outcome measures being the proportion of clinically clean bone samples sent and subsequent impact on changes to targeted antibiotic therapy. Secondary outcomes included the rates of re-infection and re-intervention.
Results
A total of 106 patients were sampled (PDSA 1, n = 52; PDSA 2, n = 27; PDSA 3, n = 27). Following the implementation of a departmental teaching programme the proportion of clinically clean bone samples increased from 68% (PDSA 1, n = 40) to 75% (PDSA 2, n = 12) with a further increase to 89% (PDSA 3, n = 24) after implementation of the online proforma (p = 0.140). Microbiology results prompted necessary changes to targeted antibiotic therapy in 58% of patients (PDSA 1, n = 33) increasing to 95% throughout the study (PDSA 3, n = 19). Targeted antibiotic therapy was associated with comparable rates of re-infection compared to non-targeted therapy (PDSA 3, 5% / 12.5%, respectively) but overall lower rates of re-intervention (PDSA 3, 63% / 47%, respectively).
Conclusions
Both interventions were associated with increased rates of clinically clean intra-operative bone sampling. Lower rates of re-intervention were observed in patients who subsequently received targeted antibiotic therapy.