Dr Dominic Sparkes is an FY1 at UCLH with interests in infectious diseases and global health.
Dr Soo Yoon is an FY1 at UCLH with interests in anaesthetics and quality improvement. @_SooYoon
Our second session involved brainstorming ideas for improvements in the hospital. Immediately, a million ideas were flowing from all sides of the group. It was almost overwhelming; some ideas were ambitious, perhaps too ambitious, and others more feasible. We structured 30 potential projects according to whether they would be generic or specific to junior doctors, patients, or certain specialties.
We thought choosing projects that would make change for many healthcare professionals would allow us to create the most change in our timeframe.
Simply, we wanted to change the world (or at least the world according to UCLH). Much debate lead to two grand plans. The first to revolutionise the medical notes system at UCLH to make it standardised across the tower. The second was to improve the phlebotomy process to avoid wastage of both time and resources.
Before ploughing through the minefield of ideas, we had to decide who was doing what. We each volunteered to join a group we wanted to work in and split into a group of six (notes team) and another of seven (phlebotomy team) – simple.
For the notes team it was immediately apparent that we all wanted to standardise organisation and improve quality of medical notes across the tower. How many times have we been running around unable to locate the correct folder on a busy ward round that never waits for you? By chance, if we located the folder without much delay we were lucky if it didn’t fall apart as we lifted out of the trolley due its large size. It was clear that we all shared the same frustrations.
While we knew that we wanted folders which were clearly labelled and easy to find, we knew it was going to take a lot more than just physical folders to revolutionise the notes system across the entire hospital. What could we change to improve efficiency for all staff members to allow easy access to relevant up to date list of current and past medical problems while not compromising patient safety or confidentiality? Another important aspect concerned who was going to maintain standards of the notes on a daily basis. We realised for us to create a system that would facilitate a “UCLH way” of doing ward round, and that engaging the multidisciplinary team was key for progress.
Initially, the phlebotomy group had a discrepancy between what we wanted to achieve and what was realistic. Not only had we decided that we were going to improve accuracy, we were going to develop a database of screening tools (eg what goes into a “vasculitis screen” or “confusion screen”) develop a website and apps.
After some (mostly cordial) discussion, we decided that we would concentrate on information about blood bottles, eg what colour bottle and which lab for particular tests. This is something taken for granted by busy consultants and registrars who say, “I want an ACTH and cortisol tomorrow” without consideration of exactly what that entails. Often as an FY1 you find yourself in a position where you simply don’t know what bottle to use, and it can be a massive waste of time finding out. This is what we wanted to change. However, our intervention had to wait. We needed to do some groundwork to establish if this was a realistic project. We needed to start pestering labs and scouring the intranet to find what information was out there and see if we could use it, and make it accessible.
The more we thought about it, the more two seemingly simple ideas had a lot of complexity beneath them. Like a QI iceberg; although the end solutions seemed simple, there was a lot of background baseline data to be gathered and lots of planning still to do.
If you have any ideas or tips to help our FY1 QI team please tweet us with #UCLHQI at @UCLHmeded and @BMJQuality.