BarwellND, DeversMC, KennonB, et al.; on behalf of the Scottish Diabetes Foot Action Group: Diabetic foot infection: antibiotic therapy and good practice recommendations. Int J Clin Pract71: e13006, 2017.
BarwellND, DeversMC, KennonB, ; on behalf of the Scottish Diabetes Foot Action Group: Diabetic foot infection: antibiotic therapy and good practice recommendations. Int J Clin Pract71: e13006, 2017.10.1111/ijcp.13006)| false
LipskyBA, SennevilleÉ, AbbasZG, : Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev36(suppl 1): e3280, 2020.10.1002/dmrr.3280)| false
ShanafeltTD, NoseworthyJH: Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc92: 129, 2017.10.1016/j.mayocp.2016.10.004)| false
SchmittM, BlueA, AschenbrenerCA, : Core competencies for interprofessional collaborative practice: reforming health care by transforming health professionals’ education. Acad Med86: 1351, 2011.10.1097/ACM.0b013e3182308e39)| false
KowalskiTJ, MatsudaM, SorensonMD, : The effect of residual osteomyelitis at the resection margin in patients with surgically treated diabetic foot infection. J Foot Ankle Surg50: 171, 2011.10.1053/j.jfas.2010.12.009)| false
SchmidtBM, McHughJB, PatelRM, et al.: Prospective analysis of surgical bone margins after partial foot amputation in diabetic patients admitted with moderate to severe foot infections. Foot Ankle Spec12: 131, 2018.
SchmidtBM, McHughJB, PatelRM, : Prospective analysis of surgical bone margins after partial foot amputation in diabetic patients admitted with moderate to severe foot infections. Foot Ankle Spec12: 131, 2018.10.1177/1938640018770285)| false
NorrisAH, ShresthaNK, AllisonGM, et al.: 2018 Infectious Diseases Society of America clinical practice guideline for the management of outpatient parenteral antimicrobial therapy. Clin Infect Dis68: 1, 2019.
NorrisAH, ShresthaNK, AllisonGM, : 2018 Infectious Diseases Society of America clinical practice guideline for the management of outpatient parenteral antimicrobial therapy. Clin Infect Dis68: 1, 2019.10.1093/cid/ciy867)| false
BerendtAR, PetersEJG, BakkerK, : Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment. Diabetes Metab Res Rev24(suppl 1): S145, 2008.10.1002/dmrr.836)| false
Background: Diabetic foot osteomyelitis is a common infection where treatment involves multiple services, including infectious diseases, podiatry, and pathology. Despite its ubiquity in the hospital, consensus on much of its management is lacking.
Methods: Representatives from infectious diseases, podiatry, and pathology interested in quality improvement developed multidisciplinary institutional recommendations culminating in an educational intervention describing optimal diagnostic and therapeutic approaches to diabetic foot osteomyelitis (DFO). Knowledge acquisition was assessed by preintervention and postintervention surveys. Inpatients with forefoot DFO were retrospectively reviewed before and after intervention to assess frequency of recommended diagnostic and therapeutic maneuvers, including appropriate definition of surgical bone margins, definitive histopathology reports, and unnecessary intravenous antibiotics or prolonged antibiotic courses.
Results: A postintervention survey revealed significant improvements in knowledge of antibiotic treatment duration and the role of oral antibiotics in managing DFO. There were 104 consecutive patients in the preintervention cohort (April 1, 2018, to April 1, 2019) and 32 patients in the postintervention cohort (November 5, 2019, to March 1, 2020), the latter truncated by changes in hospital practice during the coronavirus disease 2019 pandemic. Noncategorizable or equivocal disease reports decreased from before intervention to after intervention (27.0% versus 3.3%, respectively; P = .006). We observed nonsignificant improvement in correct bone margin definition (74.0% versus 87.5%; P = .11), unnecessary peripherally inserted central catheter line placement (18.3% versus 9.4%; P = .23), and unnecessary prolonged antibiotics (21.9% versus 5.0%; P = .10). In addition, by working as an interdisciplinary group, many solvable misunderstandings were identified, and processes were adjusted to improve the quality of care provided to these patients.
Conclusions: This quality improvement initiative regarding management of DFO led to improved provider knowledge and collaborative competency between these three departments, improvements in definitive pathology reports, and nonsignificant improvement in several other clinical endpoints. Creating collaborative competency may be an effective local strategy to improve knowledge of diabetic foot infection and may generalize to other common multidisciplinary conditions.
Corresponding author: Vimal Jhaveri, MD, Beth Israel Deaconess Medical Center, 110 Francis St, Ste GB, Boston, MA 02215. (E-mail: email@example.com)