Publication, Part of National Diabetes Foot Care Audit
NDFA Interval Review: July 2014-March 2021
Audit
Updates to mapping of foot care services
This report was updated on 21 June 2022. The following updates to the specialist foot care service mappings used in the analysis have been applied:
• Service RW501a has been mapped to RW5, rather than RW4
• Service RW501d has been mapped to RW4, rather than RW5 (as intended)
• Service 7A3C7c has been mapped to 7A3, rather than 7A5
• Service 7A3C7d has been mapped to 7A3, rather than 7A5
• Service 7A3C7a/7A5B1a is still mapped to 7A5, rather than 7A3 (as intended)
• The name used for service R0B0Qa has been standardised to: "South Tyneside Inpatient Podiatry Team". R0B0Qa was previously listed with two names: "South Tyneside District Hospital" and "South Tyneside Inpatient Podiatry Team".
The updated mappings have affected:
NDFA Interval Review: July 2014-March 2021:
https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-footcare-audit/2014-2021
• Text on tab "3. Findings": 3.4. Regional variation: Alive and ulcer-free at 12 weeks
https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-footcare-audit/2014-2021/findings
• Text and Appendix 5.8 on tab "5. Appendices": https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-footcare-audit/2014-2021/appendices
NDFA Interval Review 2014-21 - Main Report v1.1 (pptx and pdf):
• Text on Slide 11
• Text and Appendix 5.8 on Slide 24
NDFA Interval Review 2014-21 - Open Data v1.1.csv:
• Updated figures where Output_Reference = "Appendix 5.8"
NDFA Interval Review 2014-21 - Audit Participation v1.1.xlsx
• Text on tab: "Title sheet"
• Mappings on tab: "Data"
21 June 2022 09:00 AM
Update to Appendix 5.6
This report was updated on 12 August 2022.
Appendices 5.6a and 5.6b have been updated after an error was identified in the analysis code. The corrected figures for 5.6a still show a steep increase in heart failure, but rates of myocardial infarction and stroke are now flat, rather than upward. Updated figures for 5.6b are similar to those previously published.
The updated analysis has affected:
NDFA Interval Review: July 2014-March 2021:
https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-footcare-audit/2014-2021
• Text and Appendix 5.6 on tab "5. Appendices": https://digital.nhs.uk/data-and-information/publications/statistical/national-diabetes-footcare-audit/2014-2021/appendices
NDFA Interval Review 2014-21 - Main Report v1.1 (pptx and pdf):
• Text on Slide 1
• Text and Appendix 5.6 on Slide 22
NDFA Interval Review 2014-21 - Open Data v1.1.csv:
• Updated figures where Output_Reference = "Appendix 5.6"
12 August 2022 14:53 PM
4. NDFA Quality Improvement Collaborative
4.1. Background
Since it was established in 2014, the NDFA has consistently found that having severe ulcers (SINBAD score ≥3) is strongly linked with poorer outcomes. This includes rates of healing, rates of major amputations and risk of death. Time to first expert assessment (FEA) is also linked to severity. Consultation among people with diabetes, healthcare professionals (HCPs) and policy-makers prioritised reducing time to FEA, and ulcer severity. The NDFA Quality Improvement Collaborative (QIC) sought to support teams to achieve this aim.
Figure 1: NDFA QIC workflow
The QIC was delivered by Diabetes UK through a face-to-face workshop and teleconferences. This supported teams to:
- Develop a local improvement team and engage stakeholders;
- Set local aims; Identify actions to meet these aims;
- Measure progress against these aims;
- Share lessons with other members of the collaborative.
20 teams from England and Wales took part in the collaboratives. You can read more about the teams and their work here: NDFA QIC (diabetes.org.uk)
4.2. Lessons
- The first available appointment might not be convenient to patients. Giving options and information about importance when making the appointment can be helpful.
- Education, telephone triage and a closer working relationships with health and social care staff who first see ulcers can be helpful.
- Reducing time to FEA results, initially, in more people attending; consideration of how to address capacity is required.
- Improving NDFA data capture helped identify issues and monitor improvement.
- Time, and support, to improve is important.
- Linking the NDFA improvement work to other local priorities, Getting it right first time (GIRFT) recommendations and wider funding is helpful.
- Teams described the impact on their data. Further work to evaluate the overall cost effectiveness of the QIC would be helpful.
4.3. Improvement actions
Improvement actions aiming to change patient behaviour so as to reduce time to FEA:
- Patient evening information sessions.
- Make self-referral.
- Patient information posters and leaflets.
Improvement actions aiming to change healthcare worker behaviour so as to reduce time to FEA:
- Seek funding for additional training, e.g. for care home staff and non-registered practitioners.
- Provide face-to-face and online training for health staff, e.g. to support identification and use of assessment tools.
- Provide open access appointments.
- Implement root cause analysis informed actions to address the reasons for delays.
- Work to increase capacity and develop closer working (including through engagement and pathway development).
Last edited: 9 January 2023 9:55 am