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Ok, so, so, so wonderful. Yeah, that's fine. Ok. Hello everyone. Hi. Um Welcome to all. We're gonna start in a couple of minutes, but I just want to wait um 34 minutes. Um Meanwhile, I would like to introduce our theme and also I would like to introduce um you can come doctor's network. Hello. Hi. Hello. Hello, everyone. So we just want to mention that who, who are we and what, why we are doing? Not uh Yasin, me and Janay and Carlos. We are four international medical graduate living in Birmingham and working here as uh resident doctors uh had some difficulty when we first moved into the UK. We had some difficulties with the system, with the NHS. And it was more related between being in a new country, being in a uh a po system too that you are not familiar with. So we thought that we should, we can create a, you can become a doctors network and we can do some teachings or webinars focusing on the area that we had a difficulty before or we had her, we struggled to understand and we thought that it might be useful for the newcomer doctors and it might be a support network and we can struggle together if you are going to struggle or you can struggle less. Yeah. Or struggle less personally. Um, for the, I think, yeah, people are coming but we're gonna wait a couple of more minutes. Um, in, in three minutes we're gonna start. Um, so personally I spent like maybe more than six months to understand all the system. So even if you have the perfect medical knowledge, um it's, it's not, it's not gonna be very helpful to understand the system because the system is so different every day, you're learning a new term and after some point, you, you're feeling exhausted. So we are just wanted to helping you to feel it a little bit less and carry on um faster and, and live, live your life in the NHS easier. So that was the main um idea and purpose of our journey. And we are so happy because we have like more than 100 70 followers in network. Yeah, that's very nice. We are really happy to see that you are joining these events and we are really, we would like to hear from you more regarding what do you need and what we can do to improve our network or support network. So it, we just want to, to be effective for everyone and help, really help in regarding the daily life and the daily lives in the NHS as well. Uh So if before starting, I think we can start soon. If you can just confirm that you are hearing us on seeing this light. That would be great. Sorry, I should have asked that before before. That's ok. Let's do um ca can you hear us and see this light? Yes, we can. Thank you. Bye. Um So it's three past six almost. I think we can start. Let's slowly start. Um So this present in this presentation will start and then I will join as well and we will try to focus more on the how to conduct audit and implement P IP. So, yeah, same stage is yours. OK. All right. Thank you so much. Um Hello everyone again. Um So I will start about the definition of audit and Q IP, what is the difference of between each other? And then after I will talk about what is the difference of research, audit and C IP. So it will give you um more idea about, um they will give you an idea for the inter uh interviews as well because when you get into the NHS interview, the one of the questions you will be hearing or you will be having is gonna be the, what is audit and what is it? What, what is the difference between audit and research? And on the top of that, we will, on the top of that, we will give you some examples for audit and for Q IP. So let's start. Um How many people we are here today? I'm just gonna check it 21 now. Thank you for all coming. And so, so if the people who hasn't um joined with the link for the in person ones, could you please just um scan this QR code and then we can get your feedbacks after it and also you can get the certificate if it's all right. Ok. Just a bit a bit. Then I think we're done seven. Um, before I start, I would like to ask you a pool. I would like to send you a pool and asking that. Have you ever done any Q IP or any audit? So I can see how many people has already, um, has know it already. Ok. It looks like 91% for now. Doesn't, haven't done any audit or Q IP. Um, 12 response, 13 response. It's almost like most of the people hasn't done any C IP or audit. That's good after that. Um, uh, after that presentation, I hope you will be feeling yourself confident enough to join or do ACI P or audit. All right, let's start. So I will talk about the basics and basics of audit and audit cycle because these are the terms you will be hearing audit, audit cycle, second cycle, first cycle. If you have done first cycle, it's different. Second cycle is different. We were talking about it and then myths about audit and C IP. So what is Q IP, it's a different thing and then research versus audit and then we will give you some examples and then after we will have a quick, quick, quick um Q and a part. So what is outed actually? So it's a um quality improvement process. Um And it's looking for i looking for improving the patient care and how it comes. So how do we do it? Um It's a, it's a, it's comparing the current standards with your practice. So you have your practice, you're seeing your practice in your daily life, but you, you're just comparing it with the current set standards because there are some guidelines, international guidelines or your trust guidelines for specifically for this topic, topic. And you have your practice audit is actually comparing both of them and seeing what you can do and then making some implements, seeing the results of it. So it's overall focusing to quality improvement and focusing on the uh improving of the patient's care. So uh the, the definition of it actually where indicated changes are implemented and further monitoring, I is used to confirm the improvement in healthcare gathering. So what are the myths about Aed? So everyone says that it doesn't, it, it's, you have to do it in the UK. It's a specific term for UK, but you don't have to be in the UK, anything, anything similar, anything that has that idea, I mean, the cycles, checking it and then doing some implements and then rechecking it. If you have this idea in your work, it is um, counted as AED. So you don't, you don't have to be in the UK. You can do it in anywhere in your country. So it doesn't have to be in the hospital setting. It can be everywhere you provide a patient care. It doesn't have to be covering the large amount of patient, of long, large amount of information. So you, that's why you don't need a complex statistics. You can use a simple statistic knowledge and that will be, that will be enough. You don't need um a lot of information like you're doing a research. So it doesn't need a month of effort. You can do it easily quickly in a couple of weeks. Even if you're doing a clinical attachment, you can do an audit as well. So, and also it doesn't have to be patient data all the time. You can only check like hand cleaning and hygiene and then you can, it can be an audit as well. So, um I will focus on these cycles and then we'll try to give more idea about the AED and, and after that, I hope it will be more clear in everyone's mind. So this uh topic, uh this sorry, this cycle is focusing on the part of the audit. So before you start the audit, you need a topic, so you have to find something that needs to be improved or something that you have in your practice and you would like to compare it with set standards. So you choose your topic and then you check the set standards in the set standards. What are you checking? You're um, looking at the guidelines or you're looking at the general knowledge but it needs to be um, needs to be like guideline. It needs to be in, in, in, in texted. So you can see and compare it. And then after you collect the data, collect the data about your practice and analyze it. What do I mean? Let's say let's continue with the same example that we talk about hand hygiene. So in our trust, there is a hand hygiene rules and then you need to wash your hands before see before touching the patient, before examining the patient. And after examining the patient and the audit can be comparing your practice with the set standards. So how can you collect the data? It's easy. So you can actually collect the data just with observing the clinical practitioners and you cannot every day, you can observe five clinical practitioner and then you can totally observe 50 clinical practitioner and you have a data and then you analyze it, see how many clinical practitioner, how many doctors um washed or use the gels to clean their hands before and after and then you analyze it. This is going to be your first cycle. This that, that was very simple um example. And um but you can improve it with other things, you can add that you can change. But this is a very uh simple idea of a. So after that, this is your sorry, this is your first cycle. Then after that, you need to make some implements. But what it can be, it can be teaching doctors. You can send an email to the groups or you can send a message to the groups. You can send an email and you can emphasize that cleaning your hand is important. Cleaning your hands might save lives. Look at these researches, cleaning hands improved our quality. Look at that. So researches that is showing cleaning hands might provide, let's say 5% of the hospital infections. And then you emphasize that idea of cleaning and is important to the other people that anything that gives that idea might be your implement. It doesn't have to be teaching session like that. We like we are talking now, it can be posters, it can be anything. And then you're just waiting for a change to see the effects, to see the, to see the effect of the implements. It can be a month, it can be a week. Depends on your topic. Then you're going to do the same cycle. Same thing, you're gonna again collect the data about it. See how are we doing right now and then you analyze it and then you compare it with your previous, um, practice. And then you say that my audit has improved hand uh, hand prac hand cleaning practice. So that's the idea. Actually, the main thing is we are looking at, um, with the main thing that I would focus is how to improve patient care. So it can be anything that can improve patient care. Topic can be anything. So when we, when we say topic, I know it might be challenging to find the, find the idea, find an idea. So, um but it's a wide range thing, you can choose any topic. Firstly, you can choose something problem in your practice. You can po point out the problem and then you can talk with your colleagues like how are they feeling about it? Are they do they also in the same um track with the um is there anything can be done in a different or in a more efficient way? So you point out the problem, but can it be changed? Can you make it in a better way then you could think about it? Um If you can't come up with any idea, you can also ask your colleagues um and to join to involve their ed or pri ideas. Um I will give you some couple of examples. For example, we're gonna do this um audit in, in the next couple of months, Vancomycin level. So in the hospitals, you're, you're giving Vancomycin um to a lot of patients, but we are not sure. Are we accurately checking the levels or are we accurately adjusting the dose? How good are we at Vancomycin prescribing or um administration? So this can be an example. Another example can be do we set the aim saturation levels accurately for C OT retaining patients? So anything in your in your daily practice um can easily be assessed and can be compared with National International or Trust Trust standards Trust guidelines can be your topic. So that was added and now we're gonna talk about quality improvement project. So there is a, it's already written here. But do you have any idea what is the difference it being c IP noted? Mhm. Ok. Um what do you see? Ok. Um so actually I'll, I'll talk about it. So um in quality improvement project, it needs there in audit, sorry in audit, then there must be a standards that you can compare with. But in quality improvement projects, standards are not clear or if there is no standard at all, if there is no standard, if there I'm gonna online. Um I think, sorry can you can hear me now? But I think it's just some part has not um transfer to you. Ok. I will start from the beginning if someone missed anything. So I will start uh talking, I was talking about cul improvement projects. So what is the difference of cul improvement project and audit? So audit for audit, there must be a standards or there must be a guideline that you can compare with. But in audit, um there is no clear standards or uh sorry. In co co improvement projects, there is no clear standards or um there is no guideline at all. So if there is no guideline or clear standards, but you point out and point out a problem, then you might go for quality improvement projects. But generally quality improvement projects are more generalized uh topics like such as improving belief system or you point out that the patient experience is not good in this wharf, then you might think about what might be the reason and then you might come up with an idea. OK. This is the, this is the reason I did a I collected the data, I made a questionnaire to the patients and they said their experience is not good because of that, that, that that and then you can make an unemployment and then you, you re out, it do the second cycle and ask your new patients about how are they feeling about their experience in this world and then you come up with the results. So as you see, there is no guideline, you can't compare the patient experience with a guideline. So in this, that, that is counted as culty improvement project, but it's a bit more generalized term. It takes longer time and it also uh might need a funding from your department. So you, you before starting to do health improvement projects, you need to be sure that your department is gonna support you otherwise, um you might, you might fail after collecting the data. So because of that, your aim should be smart. This is a um term that we used to give you more idea about the aci so it needs to be specific, do not make it too broad for especially choose something you're interested in, choose something specific. And also that data that the things that you're gonna collect needs to be measurable. So you might ask questions and collect the data about it, but it needs to be measurable. So it's, it's, it, it, it, it needs to be also achievable. Um Because if, if you cannot collect the data easily, it's not gonna be smart. So and also the topic needs to be relevant to your um patient care or clinical practice. And most of us working in while we're working in NHS, we are rotating one department to another department in six months or a year. So um it needs to be also time defined because otherwise you might um not finish your project before um before the end of your rotation. So uh this is another um term that we use P DSA plan. So define the objective, find the problem, ask the questions about what, what, what is the reason of it and then carry out the plan, collect the data and analyze the data you have. So actually this is the, this is just giving you more idea about the cycles of A that, that I have already mentioned before. Just I want to emphasize what is it? And then you study, complete the analysis of data and compare the data with um predictions. Um summarize what you have learned of course and then act to some implements and decide what you can change and do the implementations. And you go for second cycle to learn to study an E again. So the last thing I'm gonna thought um gonna be researched and audit. Um I would like to give you a pool, 11 more pool as well. Oh, it's not sorry. OK. Uh This is um just gonna be a question to all of you. What, what might be the difference between research and out this? Do you have any idea? I might check the um messages in medal as well if anyone wants to re reply and will be watching your message. If not, I can ask to Alice. Um So would you like to give us like any, give us any information about the differences between research and audit? So research and audit um I mean, I will answer from my perspective before coming to UK. So they were quite like intercalated terms for me before coming to UK because I wasn't able to differentiate what is audit and what is the difference between regular research like the uh the research that we are with? But I understand research is more like the driven and it's more focused on the new development of the treatment or the new diagnosis or anything new. But audit is more like related to develop improvement of the clinical practice. The focusing main, main goal in the audit is mostly like to improve the clinical practice and the impact on the patients. So it doesn't look for any novel treatment or novel drugs or anything. So it is the main difference between the research and all this. I can think now. Um I don't know, I don't think that there is a security between them. They are completely different areas and we cannot say that research is spirit audit or otherwise. So their aim and the objectives are quite different and they uh real is different as well. Yeah. Brilliant. Yeah, brilliant. Thank you. Um That, that's so true. Actually, research is, as, as said, is concerned about discovering um new things and as as as uh doctor said about it, concerned about discovering right thing to do, but our, it is ensuring that we are doing right. So it's different things and it's like different areas. But research is more likely discovering new things or novel drugs, no treatment. So that's why research is asking what is the best practice. So we let's find the best practice with asking hypothesis, finding new, do new um treatments, new medications, new um new, new, new care practice to provide the best practice. But all of it actually aims the question. I sorry, ask the question of, are we following a best practice? Are we doing it everything as it needs to be done? So and also what is happening to patients as a result of the best practice? So it's asking two different questions and also a um doesn't involve completely new treatment but it involved the care you're providing and in compare the care. But clinical research trials is, may involve complete a new treatment or practice and it's used as control groups, placebo treatments. Um But in AED, you, you might involve patients but you, you don't have any control groups or you don't have any uh placebo um treatment groups and you don't have any different groups. So we are gonna give you two more examples. Um Please present me on project on conducting. Uh We're gonna continue and have the questions uh after doing the examples. Um in that, in that uh stage, I will give uh stage to Doctor Demi and she will talk uh about the audit and copy examples. All right. Thank you. Thank you explaining the concepts as well. So as Yasin explained that we have two different concepts. One is uh audit and one is C IP. And these are the concepts that we are using in our clinical practice in UK and these are different from the general research that we are aware of or we are fem with. So as you mentioned that we will give you two examples today and we will just, we will not go into detail what we've done in these projects. But we will aim to uh tell you about that, what was our aim and how we approach this aim and how we perform the C IP and audit projects. And it, I think that it might be an example to understand the system more or how to do it. Because when I first started to do audit, I was lost because I know what it is. I know of the theory behind them. I know the concept of audit. But the thing is that I didn't know where to start or how to do that. And what I did usually, I read on Google, I searched for the audit and P RB projects to understand how the other people are doing and what are their pathways mainly. So the first example is the au belief system. This is a project that Yin and I did w when we were in the acute medicine rotation. And as Yasin mentioned that uh for an audit or IP, you need to point out a problem. This is usually originate from your personal experience or your observations. So when I was, when Yin and I were in the AM U carrying beliefs during the on call or night shifts, you realize that we are having too many beliefs and sometimes these beliefs are affecting our practice causing some disruption and it might affect patients care as well. So these beliefs are usually for the a good medical doctors and these are the beliefs that Ed stuff uses for the patients or like the questions related with the patients to uh trust, like refer to the AM U. So this is the belief system just like background idea. So a new doctors carry beliefs for Ed to contact them to regarding patients in the Ed well under admitted under the acute medicine team or report to the Acute medicine team. So and after that, we are experiencing that, that we are seeing uh uh like we are getting many good numbers and sometimes we are getting misdirected calls and it uh affects our efficiency during our shifts. And then we discuss with the medical registrar because we experience that as Sh Os and then we discuss with the registrars and we found out that they also have this problem and they are experiencing that more like inappropriate beliefs, which might meaning that the belief for meant for medical about the the e stuff believe spr instead of the medical or vice versa. So this is a problem and we just need to focus on that if it is real problem experienced by others as well, because personally we experience that but we should, we need data to show that it's a real problem and that we need to focus on that. But before starting that, I need to ask that? Do you think um this is AQ IP or audit like what is the most suitable form for this problem? So if you can fill the pole, do you think none is this problem? The belief, a new belief system problem that we are experiencing is more suitable for Q IP or an audit and we can discuss on that. So we got 58 response and most people saying that it's Q IP. So I think it's correct although Q IP and all these are not like that, uh clearly differentiated terms. Uh For example, if you have a local trust guideline regarding the belief system, you can do that as audit as well because you have a standard, but mostly we don't have a standard guidelines or standard rules regarding the belief systems. So it's more like the in the realm of the P IP. And because you don't have standards to compare and it provides you more area that you can focus on, you can aim. So we considered this project as K IP as well. Although it's not the perfect example of K IP, because it was our first project as like audit and K IP. So it's like some aspects as well, but it is most more suitable for the K IP rather than audit. And after a identifying the problem that we are thinking that aim belief system is not effective that as we wanted, we need to collect the data to understand this and how can we collect data? Like what we should check the efficacy of the aim belief system? Any idea like what we can check to understand that if it is a real problem or not any idea form in person. No, uh you can write a check if you think any like clinical or any factor that you can see that we can check for the efficacy of the belief system. OK. No response. So I guess that for example, uh so we have ami beli system. So we have Ed staff who are calling the AE doctors and also we have a doctors who are having a believe, believe from calls from the Ed. So main issue might be dissatisfaction because it's a system and it's a service that has two sides and these people might be uh in satisfied with the system or may cause some problems and the other things might be the, yeah, like as said, the questionnaires is a good example to understand the satisfaction and the surveys. And this is what we done exactly. We did surveys on the ED stuff and we did surveys on the AM U stuff as well. And also we want to check some current state data but by checking the belief numbers and at that time, we had three beliefs, two for Sh Os and one for the medical registrars and they were reported like meant to be specific parts of Ed. And we went to our belief system management system. And we asked for the belief numbers over the, for example, one month to check that each belief got how many beliefs in the last one month. And we had a number and we can check that with the comparison to see that if the intervention that we are doing might cause any improvement or not. So this is the pre pre intervention data. We collected surveys and they believe numbers and this is the metal that's, it's not going, I think it's going, it's the next new slide, isn't it? I can see it. That's, yeah. So we collect data retrospectively. So that's the good side of the audit. And ci ps you can collect data retrospectively. So it, it shouldn't be, it's not necessarily to be prospective or something. And we performed survey on the ED stuff to understand the efficiency of the a belief system. And we ask that if they know who to call for the following areas and if they think that they get timely responses to their beliefs, so this shows the satisfaction also did and it also shows the knowledge of the ED stuff regarding the belief system. And we also have from the same survey on the AM E doctors asking that how they are feeling about the frequency of call they receive or the appropriateness of the calls and how they think that uh this affects their work. Also, we asked a recommendation for reducing inappropriate calls because it's APR P and you need to create a new formula and you need to find, you need more like uh how safe, more uh aspects of the concept. So you need to talk with the people and we did this on our survey to check that if there's any possible potential intervention that we can focus on. And this is just an example. We did first cycle in the October November 2023. Then we did an intervention after collecting data and our first data showed that only 42 of first of the ED stuff was thinking that they received timely response stably. So it's a quite low number when you think that the ed emergency patient and probably affecting the patients care. So focusing on that is 42 and the a survey on the AY doctors showed that um 60% of the A I doctors felt that they receive beliefs too frequently or inappropriate calls. So these are the showing that the problems that we are experiencing personally is a general problem experienced by others as well. And it shows that the belief system is not that much effective. So given that result, we did some interventions and these interventions, uh we decided after discussing with our registers with consultants and the team as well. So what we did, we did a new beliefs, implant, a new belief. We had already had two beliefs and the one registered beliefs. But in our design, we had different areas. So we created a new belief system, new belief number uh for a particular area of the ED where we think that it might be causing some historic call as well. And we performed some posters to educate the ed of whom to call for the patients in the rich area. And then we repeated the second cycle of data collection. And what we collected was exactly the same data that we collected in the first cycle because we want to see any if there's an improvement or if, if there is any worsening in our results. And and it is a is an example, as I said, that we create a new belief and we did posters and you can see that posters. It's quite simple one, it's not complicated at all, but it's, it's kind of trains the ed stuff to whom to call for which patients, for example, for patients they need to contact registrar while for example, for minor issues in a which is the most likely the minor issues area for the medical sho. So we just aim to um more like the forward the right close to the right person and improve the belief system. And after that, we repeated our cy cycles and our data collection and we did the repeated survey on the this stuff, we repeated survey on the a doctors and we also contact our belief management system. And we asked the new belief numbers. So as you can see that we first collect data on the, hey uh one second, we first collect date on the October November time. Then we implant new on the February time and we did the second cycle in the April. So it's important because we gave some time to see the change, the effect of the change. If you do the second cycle very quickly, you might not see the if there's any change or not. So it's important to give it that time if you did an intervention. And as a result, we found that there was an improvement in the belie numbers. So we saw that after our interventions, we found that there was a decline of like 11 belies per day. So it was like 10% of drop and it's a significant drop if you are carrying a believe on cold, like if you experience that one, and we also found that this drug like this reducing believe numbers were mostly in the registrars which might show that maybe registrars are now getting more appropriate calls, not the misdirected calls. So this might be showing that our interventions cause some improvement. And also we checked the A sub and we improved knowledge of the Ed stuff. And we found that after these interventions, the ED staff were knowing to whom to call. At least they were knowing the which is carried by whom. So they were calling the right person and also A B doctors uh experience shared their perception that they had more positive perception regarding the time responses and appropriateness of the relevance of the numbers. So these are an example of P RP and it's quite simple one. It's just like you experience the problem and then you sit down with your friends and focus on how you, what you can do. You collect the data and you show that it is a real problem experienced by others as well and it needs intervention and regarding intervention, it a bit creativity, you can do everything but it's just need to be more er since that, that's smart as well. So for example, if it is API P, you might need funding, although we didn't need funding. But for example, we asked the management system for a new glib. So these are the factors that you should foc focus and on the P I PS. And the second one, the second example is the POSTOP early mobilization. So I will, I did this audit when I was in thoracic surgery rotation and as a background after the thoracic surgery patient or after any surgery that we have enhanced recovery after surgery guidelines, which advises the patients should ideally be immobilized on the day of surgery, POSTOP to improve the POSTOP recovery and potentially minimize the postoperative complications. And we just want to make sure that we are practicing thoracic surgery department in the hospital was uh in compliance with this guidance. So it's a quite easy question. Well, I will ask that if you think that it is, is this question and this aim is more suitable for Q IP or audit? Ok. So yeah, as you said, it's quite straightforward. So we have a guideline and we have a standard and it's a nation guidelines like the, every thoracic surgery department has these guidelines and these recommendations that every patient if it is safe should be mobilized on the day of surgery POSTOP and it affects the postoperative recovery. And to understand that if our practices was in compliance with that one, what we done, we need to collect data and how you can collect data on the POSTOP early mobilization. Like why you can't check, do you have any ideas or any comments on that? You can text me chat as well. What do you think? For example, if you want to see that if your patients are early moil on POSTOP day zero as according to the guidelines or not? What do you check any idea for me in person? Yeah. See what we check. Mm. We can check the patient noting and then see when they have first mobilized. Mhm. Um Physical noting me they leave, they, they mobilize the patient. Yeah. Yeah, you are correct. This is what, what we done, we check the patient noting although sometimes it might be lacking noting regarding that it might be not like 100% reliable because sometimes they just don't recommend that if patient has set up or like has worked or not. Well, it is the easiest way that you can check that if your patient is mobilized on POSTOP day zero. So, so what we've done, we checked the postoperation assessment, not. And the patient system note in the electronic system to check that if patients were mobilized on the POSTOP day zero, if they mobilize, what did they do? Did they sit up or did they go to toilet or did they walk around? Like what kind of the mobility? What is the level of mobility? And also sometimes they can document that why this patient is not mobilized or immobilized. So it can also assess you to identify the reasons of the delayed mobilization. And it can also, for example, we also checked that because we thought that it might be related to coming from the recovery. So arrival time from recovery because we know that uh nursing stuff or physio stuff will help with immobilization to patients because we are not like uh we don't want the families to help them with the mobility in the post of day zero. So it's more like our healthcare staff will help with the mobility. So it's a question that if there's enough stopping or like who is doing this mobilization, et cetera and what we found out is a preintervention data we found in our first cycle that only 30% of our patients in the thoracic surgery department was mobilizing POSTOP day zero. While Ir guidelines say that it should be around 100% if it is safe for patients. So it's quite well below the guidelines asserted. And also we found that it, it was different, like the moment rate in the post was different between the patients who are coming from recovery before five o'clock and after five o'clock. So it kind of showed that where you can do an intervention as well because it shows you that a potential factor in influencing the mobility. But also you know that other than this uh health care related factors, health care stuff and the hospital related factors. It's also important the patients pro operation, mobility comorbidities, surgery they have. So there are some patients specific characteristics as well. But in this audit, we are more focused on the uh factors that we can uh improve. So these are all that kind of has this uh diagram showing that it should be a kind of circle showing this ongoing improvement and the monitoring. So we did our first cycle retrospective data collection for the November and December. Then what we done, we did an MDT training in the ward regarding the importance of the early mobilization on POSTOP day zero. And we had physio team there, we had healthcare professionals, nursing staff and doctors as well. And we focused on that uh the importance of the mobilizing thoracic surgery patient in POSTOP day zero. And then after that, we repeated our second cycle and we collected same data to see that if there was an improvement in the uh mobility rates, and I will not go into details or I don't come to read the text. I am just using this slide for this uh diagram. And after that, we did another posters because we found that there was an improvement but it wasn't that significant improvement. So we did another cycle. We did a second intervention which was the posters just reminding doctors to encourage patients to mobilize on POSTOP day zero. And document is on their POSTOP assessments and then we repeated the third day to cycle as well. And as a result of the two intervention, the first one is training and the second one is the posters just reminding to doctors to encourage patients. We found a significant increase as you can see from the graph from 30% we found the increase to the 80% in the ward that patients mobilize in POSTOP day zero. So that's a significant improvement. Although it's still below the guidelines, it shows that your intervention might affect and might cause an improvement in your patient's care. Although we don't know really, we don't investigate that if this increasement in the POSTOP day zero mobility cause an positive outcome on the patient's recovery. But this shows that your practice has been improved and your practice is more in compliance with the guidelines at the moment. So this shows, well, this also showed that if because we collected data for specific surgery types and for specific locations, for example, HD U high 10 units and regular work patients, we found that for example, uh work patients were mobilizing more. So it also shows you the area of improvement saying that you can do a third intervention focusing on the two areas or the areas that need further improvement. Yeah, so that one is third site like three cycle, which is called closed loop cycle audit as well that we done in the thoracic surgery department show that it is really important to identify the problem and do targeted intervention. And hopefully, at the end, we see an improvement in our, in our care clinical practice and hopefully it will cause positive outcomes for the patients. So that's the all of the aim of this A and P IB actually just to improve the patients outcomes at the end. Uh So these are the three examples that we had in our uh practice we did recently. Well, as I said that they are not perfect examples and there are many different areas that you, we need to focus and develop our practice as well. Well, I hope that it gave you an idea of how to do an audit or P IP or like where and how was others people's experience. Uh Do we have any questions? So we can do a KK section now? And we will share feedback as well. So if you can fill this feedback form, you can get a certificate for this teaching as well. Although I'm waiting for the uh questions that you might have or anything, we can have a discussion about, like if you have an audit or P IP project and you don't know where to start. We can have discussion here. So you can have an idea from other people as well. Any questions from here? No, that's good. That's all right. OK. Yeah, of course, we can try to help you out. But as I said that Yin and I also like the doctors that in the process to understand what is A and P RP. But I'm happy to help you meet your questions or to help with your project. I'm not sure I'm not saying that I'm expert on this, but I'm happy to help you, right? Any other question or any other feedback you want to share here or no? Uh OK. Then thank you for attending. We really enjoyed this whole session and I hope, I hope that it was effective for you as well. OK. And gene results. So any general comments on combining all these P I PS on A I based interventions or technologies? So A I based interventions or technologies in, can I answer that question is all right for you. So the thing is that A I interventions or the technologies in the medical field is still a topic of the research, still difficult to research. So if you are by saying that the use of A I, are you meaning to introduce a new diagnosis system or new practice in our system? It should be first for the research to understand that the outcome of the these new interventions. But as you said that it's probably quite IP because we don't have any standard guideline for A I. But what you can do, for example, especially if you are in Radiological uh department, you can check your use of the A I in your practice and use uh like compare with your regular current practice. So it's more K IP. But as I said, I it's still in the realm of the research. And after we know that there is an evidence that A I based interventions are effective and safe to use on among patients here, then you can perform auditor K IP as well. I think so in, in that case, uh first, we need to be sure that using the A I um in that area uh is safe to do so if we know that it's safe to do and it's proved that we can use it then and after researchers, of course, then you can compare it with your practice and using A I it, it's, it's, it sounds like it might be a project. Well, it a general, the, the question you're asking is a bit generally, it depends on the what you are looking and what is your aim to use A I. So it might be audit as well. Like depending on the, what is your goal to use the A I BASED intervention? Like for which question for which aim? Which objector? Yeah, that's really good. For example, nice. If nice recently included the guidance on the A I detection of fracture from x rays, you can do that A as audit because you have a guidance or you can do it as C IP in your department and in your trust as well. So it's a good idea and hopefully they will have that. Uh I'm not really familiar with the A I issues. Unfortunately, I'm a bit boomer on that topic. But yeah, II saw some A I discussions in the me and we can also ask some experts in the A I to have a discussion on that. At least discussion on the nice recommendations to use of A I. Yeah, that's a good idea. Thank you. Any more comments or questions. Thank you very much Lia for nice comment. Hopefully it's helping you guys because we just want to help someone. And as as we said that in the beginning, we just want to struggle less together and hopefully have it like relax working environment for all of us and improve our practice. At the end. And we would really appreciate that if you can provide me us for more feedback regarding the teaching needs, what you want to us to talk about. We can, of course, we are not the expert on every topic so we can ask the people to come and have these sessions that you need to discuss or you need to have a teaching. Thank you very much. So, I'm ending this session. Well, just uh I'm not sure if he say recorded that one. If it is recorded, we will be able to uh upload it to the meal as well. Well, we can repeat this session if you want as well. So we are always happy to repeat it. So I am finishing this session. Could you help me with that? Sorry. Thank you for coming all and thank you for attending online as well. Thanks everyone. Um See you in the next session. Yeah. Uh yeah, our next session will be on core surgical training application and we are planning it to be on Sunday. Uh We will create event and we will share details. So if you are interested in the surgical training applications or any portfolio requirement for CSD, we are waiting for you to join this session on Sunday on Sunday, Sunday. Yeah, but we will share the details. Ok, thank you. See you see everyone.