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QIP & Audit Paediatric ST2, RHCYP • What is the QI vs Audit • Understand the basic building blocks of QI and Audit Objectives • How to get involved in QI and Audit • QIP & Audit component of the paediatric training applicationBasics of QI & AuditWhat is Quality Improvement? Quality Improvement has been defined in several ways • Improvement in patient outcomes, system performance, and professional development that results from a combined, multidisciplinary approach in how change is delivered • The delivery of healthcare with improved outcomes and lower cost through continuous redesigning of work processes and systems. • Using a systematic change method and strategies to improve patient experience and outcome • To make a difference to patients by improving safety, effectiveness, and experience of care by using understanding of our complex healthcare environment, applying a systematic approach, and designing, testing, and implementing changes using real time measurement for improvement. • Primary Intent • Employing an iterative process of testing change ideas • Consistent use of an agreed methodology Principles of QI • Empowerment of front-line staff and service users • Using data to drive improvement • Scale-up and spread, with adaptation to context PDSA Cycle of QI QI can be done using the plan, do, study, act framework. PDSA cycles are iterative and have short time spans allowing improvement to be incorporated quicklyAlternatives to QI What other approaches to improving healthcare are there? • Research—The attempt to derive generalisable new knowledge by addressing clearly defined questions with systematic and rigorous methods • Clinical audit—A way to find out if healthcare is being provided in line with standards and to let care providers and patients know where their service is doing well, and where there could be improvements. • Service evaluation—A process of investigating the effectiveness or efficiency of a service with the purpose of generating information for local decision making about the service. • Clinical transformation—An umbrella term for more radical approaches to change; a deliberate, planned process to make dramatic and irreversible changes to how care is delivered. • Innovation—To develop and deliver new or improved health policies, systems, products and technologies, and services and delivery methods that improve people’s health. Health innovation responds to unmet needs by employing new ways of thinking and working.What is Audit? • Clinical audit is closely related to QI: it is often used with the intention of iteratively improving the standard of healthcare, in relation to a pre-determined standard of best practice. • Audit can be used to establish a baseline and to analyse the impact of tests of change against the baseline. When used iteratively, interspersed with improvement action, the clinical audit cycle adheres to many of the principles of QI. • Audit is often the first step in a QI process and is used to identify improvement opportunities, particularly where compliance with known standards for high quality patient care needs to be improved. • In practice clinical audit is often used by healthcare organisations as an assurance function, making it less likely to be carried out with a focus on empowering staff and service users to make changes to practiceThe Clinical Audit Cycle An FY2 is asked to complete an audit of a pre-surgical pathway by concludes that adherence to best practice is mixed and recommends: “Remind the team of the importance of being thorough in this respect and re-audit in 6 months.” The results are presented at an audit meeting, but a re-audit a year later by a new FY2 doctor shows similar results. Before continuing reading think about your own practice—How would you Scenario: approach this situation, and how would you use the QI principles described in this paper? Closing the Loop Now contrast the above with a team-led, rapid cycle audit in which everyone contributes to collecting and reviewing data from the previous week, discussed at a regular team meeting. The team identify and test several iterative changes to care processes. They document and test these changes between audits, leading to sustainable change. Some of the surgeons involved work across multiple hospitals, and spread some of the improvements, with the audit tool, as they go.Getting involved in QIP & Audit • Contribute to improving patient care. • It’s a great way to show interest in a certain field. • You’ll learn many transferable skills, for example, teamwork, Why get time management. • Opportunity to present at conferences or write up for publishing. involved in • Completed audits are extra CV points for specialist training. audit and QI? • As a doctor, it may form part of your annual appraisal and assessments! • It is a mandatory requirement for UK junior doctors to progress in their training.How to Get Involved? There are 2 ways of getting involved in audit/QI: 1. Joining an already organized audit 2. Setting up an audit yourselfJoining an already organized audit 1. Ask doctors if they have any audits that you could help with. 2. In the United Kingdom, trainee research collaboratives such as STARSurg run multicenter national audits. Here there is a protocol, and your role is to do the data collection at your site. The data is often processed centrally. 3. University societies such as Acamedics have many audits available for students to get involved with that have already been planned by doctors. PROS—good introduction to auditing, less time commitment. CONS—less flexibility, fewer skills learnt, fewer potential perks—for example, conferences/CV points.Setting up an audit yourself • Use the SMART criteria when thinking about planning • Remember to get permission from the audit lead of the department and register it with the audit department. Involving seniors may make implementing change easier and will prevent you from doing an audit that is already being done. • Engaging all stakeholders or people whom your work will impact (nurses, physios, pharmacists, etc., in addition to doctors) early on is vital, and gaining their feedback will be useful. • Reauditing is a MUST. Doing this 3 times will achieve maximum marks in most training applications. An audit that has a high turnover of patients and an easy change to implement is easier to reaudit than one with lower numbers of patients and a more difficult intervention. • Present your results at meetings/conferences and report with SQUIRE Guidelines PROS—more flexibility, more CV points. CONS—bigger time commitment, more admin/planningQIP/Audit component of the Paediatric PortfolioPaeds Person SpecificationScoring Criteria Total score = 33Online Application Portion ExampleInterview Portion • What is Clinical Audit • Tell us about an interesting audit that you did • the audit processlems associated with • What is the difference between audit and research • Audit and QI projects (QIPs) are very similar, they both look at how health care standards are, and aim to improve them • Audits have a more formal standard to measure against(best practice) and tend to have a longer time period • While PDSA cycles used in QI can be weekly or even daily Take home and focus on overall experience improvement Messages • Getting QI and audit experience is possible when working in any department, benefits you in many ways • When applying, getting your audit/QI requirements for your portfolio is easy, so don’t let those 3 points slip away!Online Resources • Elfh: About the Research, Audit and Quality Improvement programme https://www.e-lfh.org.uk/programmes/research-audit-and-quality-improvement/ • HQIP: Guide to involving junior doctors in clinical audit and quality improvement improvement.pdfp.org.uk/wp-content/uploads/2018/02/guide-to-involving-junior-doctors-in-clinical-audit-and-quality- • BMJ Article: How to get started in quality improvement BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.k5437Thank you!