A Closed-Loop Quality Improvement Intervention to Enhance Diabetic Foot Risk Assessment Compliance at Atbara Teaching Hospital

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Background and objective Diabetic foot complications are a major cause of morbidity and preventable lower limb amputation among patients with diabetes mellitus. Despite clear international guidelines recommending routine structured foot risk assessment, adherence in hospital settings remains inconsistent. The objective of this study was to evaluate baseline compliance with diabetic foot risk assessment documentation and determine the impact of implementing a structured assessment tool and targeted staff education. Methods A closed-loop quality improvement project was conducted at Atbara Teaching Hospital. The first audit cycle (August 2025) included 50 hospitalized adult patients with diabetes mellitus. Following baseline assessment, a standardized diabetic foot risk assessment checklist was introduced with staff orientation and workflow integration over a two-month intervention period. A second prospective audit cycle (November to December 2025) assessed 50 consecutive patients using identical criteria. Compliance with guideline-recommended assessment components was compared between cycles using chi-square testing. Results Baseline documentation of key risk assessment components was low, particularly for neuropathy (8; 16%), peripheral arterial disease (3; 6%), and risk stratification (0; 0%). Following intervention, compliance improved significantly across all clinical domains, reaching 50 (100%) for neuropathy assessment, vascular assessment, risk score calculation, and follow-up planning (p < 0.001). Documentation of patient identifiers showed minimal change, except for file number recording, which declined significantly from 45 (90%) to 28 (56%) (p < 0.001). Conclusions Implementation of a structured assessment tool combined with targeted education significantly improved compliance with diabetic foot risk assessment standards. Structured quality improvement strategies represent an effective approach to bridging gaps between guideline recommendations and routine clinical practice.

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