Improving Early Identification and Documentation of High-Risk Diabetic Foot Complications Through a Closed-Loop Clinical Audit at Almanagil Teaching Hospital

Abstract

BACKGROUND: Diabetic foot complications are a major cause of lower limb amputation, with delayed risk identification and inconsistent documentation contributing to poor outcomes, particularly in resource-limited settings. This clinical audit aimed to improve early identification and documentation of high-risk diabetic foot complications at Almanagil Teaching Hospital. METHODS: A closed-loop clinical audit was conducted over two cycles at Almanagil Teaching Hospital. Fifty consecutive medical records of patients with diabetes presenting with diabetic foot ulcers or suspected infection were reviewed in each cycle. Following a baseline assessment, a targeted quality improvement intervention was implemented, including staff education and the introduction of a standardized diabetic foot risk assessment and scoring tool. Documentation practices before and after the intervention were compared using descriptive and inferential statistics. RESULTS: At baseline, documentation was incomplete across most domains, with patient identifiers recorded in 22%-60% of records and key clinical assessments such as neuropathy, peripheral arterial disease, and infection documented in only 8%-18%. Following the intervention, documentation of patient and clinician identification reached 100%, while neuropathy and peripheral arterial disease assessments increased to 98% and 96%, respectively. Infection and skin integrity assessment improved from 8% to 94%, and objective risk stratification using total risk score calculation increased from 2% to 92%. Documentation of follow-up or clinical intervention rose from 22% at baseline to 96% post-intervention. All improvements between Cycle 1 and Cycle 2 were statistically significant (χ² tests, p < 0.001). CONCLUSION: Implementation of a structured diabetic foot risk assessment tool supported by focused education was associated with marked improvements in documentation and early risk identification. These findings highlight the effectiveness of audit-driven quality improvement strategies in strengthening diabetic foot care processes and support their wider adoption in similar healthcare settings.