Establish General Aims: Diabetic Foot Infections

Establishing appropriate goals is essential for maintaining focus and motivating the team.

Eventually your aims should be specific, measurable, and time defined and should specify the population or populations for whom you want to improve care. A “stretch” goal should be established that should be aggressive enough to mandate a change in the design of your current process in order to achieve it. Until you have reliable metrics and a baseline evaluation, however, team-supported general aims or goals can be important for galvanizing action and establishing clarity of purpose.

Consider drafting a team charter for review and approval by the group. The charter should state the members requested, responsibilities involved, and goals of the team

One important task is to define the scope of your efforts. We encourage a broad view of the scope of your efforts as affecting all aspects of the care of the patient with a diabetic foot infection, but it may be reasonable to start small and then spread your improvement methods to other areas. On the other hand, whatever the scope of your effort, the interventions you choose should be piloted on a small scale when possible. The bottom line is this: think BIG! Don’t bite off more than you can chew initially, but serial testing and learning on a small scale can make even very large projects more manageable.

Examples of general aims:

1. Increase the number of patients with appropriate culture specimens obtained in the first 24 hours after admission.
2. Increase the number of patients who undergo early bedside wound debridement
3. Improve the percentage of patients who achieve adequate glycemic control in the first 48–72 hours after hospital admission.
4. Increase the number of patients who leave the hospital with adequate plans for ulcer off-loading in place.
5. Increase the ratio of low-level (i.e., transmetatarsal and more distal) to high-level amputations.

As your team develops, your challenge will be to define many of the terms in your general aim, which will entail developing defined metrics and more mature, specific, time-defined aims. For example, what aspects of diabetic foot infection care do you want to improve first? What are the factors that lead to a failure of conservative management, especially to the need for high-level amputation? How do we educate caregivers about the care of diabetic foot infections, increase the rate of ulcer healing, and reduce the number of high-level amputations?

TASK: Establish general aims
Task assignment: The Improvement Team
Due Date: First team meeting