Improving the outcomes of foot and ankle surgery. Professional impact of the Australasian College of Podiatric Surgeons’ audit tool

Abstract

{\ensuremath{ }}Background{\ensuremath{ }} - Surgery is an example of expanded practice scope that enhances podiatry and incorporates inter-professional collaboration. By 2050 demand for foot and ankle procedures is predicted to rise nationally by 61.9%. Performance management of this increase motivated the development of an online audit tool. Developed in collaboration with the {\ensuremath{ }}Australasian College of Podiatric Surgeons (ACPS){\ensuremath{ }}, the {\ensuremath{ }}ACPS{\ensuremath{ }} audit tool provides real-time data capture and reporting. It is the first audit tool designed in Australia to support and improve the outcomes of foot and ankle surgery. {\ensuremath{ }}Methods{\ensuremath{ }} - Audit activity in general, orthopaedic, plastic and podiatric surgery was examined using a case study design. Audit participation enablers and barriers were explored. Case study results guided a Delphi survey of international experts experienced or associated with foot and ankle surgery. Delphi survey-derived consensus informed modification of a generic data set from the {\ensuremath{ }}Royal Australasian College of Surgeons (RACS){\ensuremath{ }}. Based on the Delphi survey findings the {\ensuremath{ }}ACPS{\ensuremath{ }} online audit tool was developed and piloted. Reliability and validity of data entry and usability of this new tool was then assessed with an online survey. {\ensuremath{ }}Results{\ensuremath{ }} - The case study found surgeon attitudes and behaviours positively impacted audit participation, and also indicated that audit data should be: (1) available in real time, (2) identify practice change, (3) applicable for safety and quality management, and; (4) useful for peer review discussion. - The Delphi process established consensus on audit variables to be captured, including the modified {\ensuremath{ }}RACS{\ensuremath{ }} generic data set. 382 cases of foot and ankle surgery were captured across 3 months using the new tool. Data entry was found to be valid and reliable. Real-time outcome reporting and practice change identification impacted positively on safety and quality management and assisted peer review discussion. An online survey showed high levels of usability. {\ensuremath{ }}Conclusions{\ensuremath{ }} - Surgeon contribution to audit tool development resulted in 100% audit participation. The data from the {\ensuremath{ }}ACPS{\ensuremath{ }} audit tool supported the {\ensuremath{ }}ACPS{\ensuremath{ }} submission to the {\ensuremath{ }}Medical Services Advisory Committee{\ensuremath{ }} to list podiatric surgery under Medicare, an outcome noted by the Federal Minister of Health.