Dr Ana Sofia da Silva is an FY1 at UCLH with interests in obstetrics and gynaecology and quality improvement.
Dr Kimberly Tagle is an FY1 at UCLH. She is an aspiring ophthalmologist interested in QI, medical education, and healthcare innovations.
@KimberlyTagleMD
It is difficult to believe that we are over half way through our first year as actual doctors; when they say time flies, they weren’t kidding. We have managed to hone the craft of writing a discharge summary, learned which wards are always fully stocked with blood culture bottles, and even picked up a few phrases that will ensure we get that CT scan before the end of the day.
The learning curve of FY1 has been steep but as that learning curve has begun to plateau, the inefficiencies in the system that prevent us from doing our job properly have become increasingly apparent. Imagine the frustration during on-call due to the amount of time wasted trying to find a set of notes, or that sinking feeling when the consultant asks for an ammonia level.
Ammonia? Where do I begin? Ask a friend? Call the lab? Or consult Dr Google? Twenty minutes later and you’ve finally worked out which bottle it goes in (it has a purple top by the way) and you then find out it’s meant to be in ice! Yes, I said ICE! Therein begins your hunt for ice across a 16-floor hospital. This highlights just one of the daily struggles of a junior doctor. The question is, how does one go about improving this?
When a very enthusiastic radiologist turns up to our FY1 teaching looking for volunteers to run some quality improvement projects, the first thought that came to mind was fantastic; here is our opportunity to actually make a change. So we decided to turn up to the first meeting, which was very enlightening. During this meeting, we heard that our colleagues were experiencing similar difficulties yet were also determined to make a change. The positive energy in the room made you want to get up and start working. We were ready to audit something, make a change, and re-audit it. Right? Wrong!
To undertake a quality improvement project you need to conduct PDSA cycles. Huh? Most of us had never heard of a PDSA cycle. PDSA stands for “Plan-Do-Study-Act”. In essence it means that rather than conducting an audit (where there is only one intervention performed), QI requires that there are a number of small incremental changes conducted over time in order to make a larger change. At each stage you measure and adjust the intervention to meet your aims, altering a little bit at each stage.
Before delving into this world of quality improvement, we were sent on a mission to come up with two projects that could be translated across our trust and involved multidisciplinary teams. Thinking hats were now firmly on!
Look out for more blogs from our FY1s coming very soon! If you have any ideas or tips to help our FY1 QI team please tweet us with #UCLHQI at @UCLHmeded and @BMJQuality.