title: A prospective audit of the impact of additional staff on the care of diabetic patients in a community podiatry service.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the impact of the employment of additional podiatry staff on patients with diabetes attending a community-based podiatry service.
  
  
  METHODS
  An audit was conducted to evaluate the intervention of two additional podiatry staff. All patients with diabetes referred to and attending community podiatry services in a specified area in the Republic of Ireland between June 2011 and June 2012 were included. The service was benchmarked against the UK gold standard outlined in the 'Guidelines on prevention & management of foot problems in Type 2 Diabetes' by the National Institute of Clinical Excellence (NICE). Process of care measures addressed were the number of patients with diabetes receiving treatment and the waiting times of patients with diabetes from referral to initial review.
  
  
  RESULTS
  An increase in the number of patients with diabetes receiving treatment was seen in all risk categories (ranging from low risk to the emergency foot). Waiting times for patients with diabetes decreased post-intervention but did not reach the targets outlined in the NICE guidelines. The average time from referral to initial review of patients with an emergency diabetic foot was 37 weeks post-intervention. NICE guidelines recommend that these patients are seen within 24 hours.
  
  
  CONCLUSIONS
  During the life cycle of this audit, increased numbers of patients were treated and waiting times for patients with diabetes were reduced. An internal re-organisation of the services coincided with the commencement of the additional staff. The improvements observed were due to the effects of a combination of additional staff and service re-organisation. Efficient organisation of services is key to optimal performance. Continued efforts to improve services are required to reach the standards outlined in the NICE guidelines.
authors.affiliation: Community Podiatry Services, North and South Lee, Grattan Street Health Centre, Health Service Executive, Cork, Ireland.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Ryan
authors.affiliation: Department of Radiation Oncology, Cork University Hospital, Cork, Ireland.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Uppal
authors.affiliation: Community Podiatry Services, North and South Lee, Grattan Street Health Centre, Health Service Executive, Cork, Ireland.
authors.forename: Imelda
authors.initials: I
authors.lastname: Cunning
authors.affiliation: Department of General Practice, University College Cork, Cork, Ireland.|Department of Epidemiology and Public Health, University College Cork, Cork, Ireland; Claire.buckley@ucc.ie.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Buckley
keywords: audit; diabetic foot; podiatry; waiting times