Why perform a QI/Audit?

QI

When doing QI projects it’s important to think about the wider clinical picture. There is no point in starting/completing a QI project that will have no clinical benefit to either staff and/or patients. 

By using the information gained in the ‘What’ section you will build on this and develop an understanding of ‘Why’ QI projects are done in this session.

First of all, let’s begin with a scenario for illustrative purposes. 

You are currently the FY1 on a vascular surgery ward. During your rotation, you have noticed that as a clinical team collectively you are very poor in completing your VTE prophylaxis forms and thus prescribing appropriate medical/mechanical interventions.  To try and improve rates of completion you have decided to create a QIP addressing the problem by performing a teaching session for the department. This would aim to improve staff confidence in managing situations, improve staff knowledge, and may improve efficiency too!

With any clinical scenario where you think a QIP could be useful think of WHY you want to do it. 

A QIP should satisfy one or more of the following?

  1. Improve patient experience 
  2. Improve efficiency – e.g in relation to waiting times due to surgical pathways 
  3. Improve staff wellbeing and morale
  4. Improve staff confidence in managing certain situations
  5. Improve staff/patient knowledge – e.g through the production of helpful pamphlets/tools etc.

Audit

After completing the proposed teaching session you could collect data on VTE prophylaxis prescribing rates before and after your teaching session to compare the change your intervention made. Ideally the set of data prior to your QIP should have been collected before your QIP as this should guide you as to whether the intervention was required in the first place! Clinical audits would typically complete one of the following below in addition to the above QIP improve statements:

  • Improve appropriateness– Is the right treatment being provided to the right patient.
  • Improve timeliness– Was the action conducted at the right time? E.g. review, treatment, referral
  • Improve effectiveness– Was the treatment given in the right way? With desired effect?
  • Assess adherence to national/regional/local guidance e.g. NICE guidelines

Both of the above may be involved in what is termed a ‘closed loop audit’. Closing the loop of an audit involves a re-auditing (collecting and analysing) of the same data after a change has been implemented (this change may constitute a quality improvement project in itself). Some applications now give more points for demonstrating a sustainable positive change from a closed loop audit that is presented at local/regional/national meetings/conference.

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