Quality Improvement: Why it’s not turfing the RCT to the long grass

We’ve started to publish a fair few quality improvement reports in the Archives recently, aiming for 1200 words, 5 references and a readable SQUIRE-compliant paper that gets across the key messages about how a #QI project was undertaken.

These aren’t trials, don’t have control arms, and may suffer from significant publication bias. (It’s not surprising to anyone that in my role as an Associate Editor, I’ve not seen a Report that shows how the QI intervention was completely bloody useless.)

So what on earth are we – EBM centric academic ivory towerists – doing promoting these things?

Well …

  1. They are not ‘research’ in the sense of generating new, generalisable knowledge. They are stories of how a group managed to do something.
  2. They say what outcome one set of folk achieved – not that it’s better / as good / worse than any other outcome (which is what an RCT might do).
  3. They are quite likely to be situation specific – like much implementation, it’s the local wiring that makes something work.
    (As an example – how do you get to the loo from the doctors office? I’m guessing that there will be a fair few right answers to this question … all of them location specific.)

QI interventions should, in my Ivory Tower Based Opinion, be about implementing something that has good research evidence behind it. If you’re reducing time to antibiotics in sepsis, can you show that this would be a good thing to achieve from more formal research?

Publishing these things is to make clear to others how solutions can be found. Perhaps think of these as the practical clinical equivalent of a nice campfire story …

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