Obtaining Institutional Support — Diabetic Foot Infection

Your team needs support from your medical center leadership to enhance your improvement effort. Getting institutional buy-in and administrative support is essential. Although you may not yet have robust data, the rationale for directing resources toward diabetic foot infection efforts can be spelled out. A direct line to administrative support for your effort, either by a direct reporting structure or by involving a senior administrator in the team, should be in place before you go any farther. One example of an approach is to have an “executive sponsor” (e.g., CEO, CMO, CNO) or administrative champion of the project. This sponsor should receive regular updates on the project (and ideally attend at least some committee meetings) and be an advocate of the project to the remainder of hospital leadership.

Task

Meet with members of your administration and have prepared “talking points” and, ideally, some preliminary information you’ve collected demonstrating the need for the administration’s attention. Talking points may include:

• Diabetes is a burgeoning epidemic in the United States.
  
• Diabetic foot ulcers/infections are the leading reason for diabetes-related hospitalization (>110,000 admissions in 2003).^1,2
  
• Diabetic foot infections are the number-one cause of lower-extremity amputations.¹
  
• High-level (i.e., above- and below-knee) amputations lead to poor quality of life for diabetics, with 5-year mortality similar to that of common deadly malignancies.³
  
• Many physicians and institutions fail to adhere to best practices for the treatment of diabetic foot infections, leading to unnecessary amputations or high-level amputations when low-level amputation would have sufficed.
  
• Multiple studies have demonstrated better outcomes for patients with diabetic foot infections in both inpatient and outpatient settings when care is delivered by dedicated multidisciplinary teams. This has particularly been true in reducing the number of amputations.^4,5
  
• Evidence suggests that in addition to improving outcomes, optimal care of patients with diabetic foot infections may actually reduce costs.⁶
  
• Guidelines have been established and could be considered the standard of care.^1,7

Case vignettes can illustrate specific issues related to the care of diabetic foot infection patients and can often be a powerful supplement to data regarding the institution’s current practice and outcomes that support the need for resources. In addition, these vignettes can highlight the areas that your initiatives are directed at improving and add the “patient’s voice” to your communications.

1. Lipsky BA, Berendt AR, Deery HG, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004;39:885-910.
2. Available at: http://www.cdc.gov/diabetes/statistics/complications_national.htm. Accessed July 20, 2009.
3. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217–228.
4. Trautner C, Haastert B, Mauckner P, et al. Reduced incidence of lower-limb amputations in the diabetic population of a German city, 1990–2005: results of the Leverkusen Amputation Reduction Study (LARS). Diabetes Care. 2007;30:2633–2637.
5. Krishnan S, Nash F, Baker N, Fowler D, Rayman G. Reduction in diabetic amputations over 11 years in a defined U.K. population: benefits of multidisciplinary teamwork and continuous prospective audit. Diabetes Care. 2008;31:99–101.
6. Ortegon MM Redekop WK, Niessen LW. Cost effectiveness of prevention and treatment of the diabetic foot: a Markov analysis. Diabetes Care. 2004;27:901–907.
7. Frykberg RG. Zgonis T, Armstrong DG, et al. Diabetic foot disorders: a clinical practice guideline (2006 revision). J Foot Ankle Surg. 2006;45:S1–S66.