{"id":43893,"date":"2019-01-17T12:48:36","date_gmt":"2019-01-17T11:48:36","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=43893"},"modified":"2019-01-17T12:50:27","modified_gmt":"2019-01-17T11:50:27","slug":"anna-olsson-brown-the-benefits-of-qi-are-numerous-and-the-challenges-worth-overcoming","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/01\/17\/anna-olsson-brown-the-benefits-of-qi-are-numerous-and-the-challenges-worth-overcoming\/","title":{"rendered":"Anna Olsson-Brown: The benefits of QI are numerous and the challenges worth overcoming"},"content":{"rendered":"

Clinical audit has long been a feature of clinical training for junior doctors, so I expected time to be set aside in which we could do it. However, the reality was hours of work, usually conducted outside working hours, rifling through archived notes in a solitary and unfulfilling manner which normally stopped when the data collection was complete. My findings were rarely implemented or re-evaluated by the same junior doctor and the opportunity to witness any improvement in patient care was even rarer. I had always engaged in clinical audit, even winning an award for the best audit in my F1 year, but I was left uninspired and struggled to see the relevance of my efforts.<\/span><\/p>\n

Unbeknown to me, however, I had actually started to engage in quality improvement activities at the end of my F1 year. I started a job in emergency medicine after my F1 job in oncology, and I noticed that the guidelines on neutropenic sepsis antibiotics were relatively unknown and even less frequently implemented.<\/span><\/p>\n

A colleague and I devised a neutropenic sepsis pathway for oncology patients in the emergency department, including an alert label for blood tests. We were supported by the lead for acute oncology. The pathway ran for six months and then an F2 colleague assessed any benefit. There was an initial improvement; however, at that stage the pathway hadn\u2019t become embedded and the benefit was not sustained after we left the department.<\/span><\/p>\n

This project preceded the introduction of the quality improvement framework<\/a>\u00a0<\/span>so it was not supported by any guidance. However, I took away valuable learning points: the importance of colleague and departmental engagement, regular reviews and updates to the implementation, and early implementation of factors to achieve sustainability.<\/span><\/p>\n

My next quality improvement project took place when I was a core medical trainee. The hospital was running a pilot to determine whether there was benefit to be gained by junior trainees engaging in quality improvement instead of, or as well as, clinical audit and, if so, whether a quality improvement framework would be useful.<\/span><\/p>\n

I looked after a patient who required recurrent ascitic drains and I became increasingly aware of the physical, psychological, and emotional impact of this process. Following NICE approval of long term drains, I was keen to set up a service to prevent patients going through this awful experience repeatedly, described by one patient as a \u201crecurrent gauntlet.\u201d The opportunity to undertake a quality improvement project seemed ideal, so a core medical trainee colleague and I developed a proposal. The project was supported by a coordinator who linked us to an appropriate supervisor, explained the quality improvement framework and project structure, and communicated regularly with us to deliver ongoing support. We had regular meetings with all the departments involved, gained insight from patients, liaised with the drain company representative, and developed a pathway and education strategy.<\/span><\/p>\n

This project taught me the importance of teamwork, implementation of small yet tangible changes, and frequent evaluation, implementing the learning points from my original project. I also learnt the utility of a structured framework to unify the intentions of a project, the importance of the management team, and that the education of the people involved in the delivery of the project is key.<\/span><\/p>\n

I have since taken on more of a mentorship role, which has allowed me to pass on some of the things I learnt from my previous projects. As an ST3 I mentored a group of junior doctors, one of whom was keen to pursue a quality improvement project. This resulted in the introduction of a syringe driver prescription sticker that remains active in the hospital to this day without either of us needing to sustain the project going forward.<\/span><\/p>\n

Factors that made this project a success were<\/span><\/p>\n