Quality and Safety

Quality and Safety

Jun 20, 2016 0
onthepods,Working & training in healthcare
Summary writer:  Elizabeth Campbell
Editor:  James Edwards
Interviewee:  Sarah Dalton

James talks to Dr Sarah Dalton about Quality and Safety for junior doctors.

About Dr Sarah Dalton

Sarah Dalton is a Consultant in Paediatric Emergency Medicine at The Children’s Hospital at Westmead as well as Clinical Director at the Clinical Excellence Commission in NSW where she oversees a Clinical Leadership Development program. She is President-Elect for the Division of Paediatrics and Child Health at the Royal Australasian College of Physicians and holds a Masters in Applied Management in Health.

Sarah has a long-standing interest in the translation of evidence into practice, and is a strong advocate for improving Quality and Safety in Healthcare. She has a particular interest in clinicians leading change and recently completed a Fulbright Scholarship to evaluate Clinical Leadership Development Programs in the United States.

Quality and Safety for JMOs

With Dr Sarah Dalton, Paediatrician and Clinical Director at the Clinical Excellence Commission, New South Wales, Australia

Introduction

Quality and safety measures are methods of making care better for our patients. There are six domains of quality and safety: care that is safe, effective, patient-centred, timely, efficient, and equitable.

Junior doctors have many opportunities to be involved in quality and safety measures in hospitals. By delivering quality care every day, and reflecting on our practice, we can all play an important role in improving patient quality and safety. As junior doctors are involved in many aspects of patient care their perspective is very important in changing practices.

Case

You are working in a team and your consultant asks you to conduct an audit. 

  • An audit, at its basic level, is a count – “how often are we doing the right thing?”
  • There are many levels of detail an audit can go into.
  • An audit is the first step in a quality improvement cycle.
  • Finding a problem and then fixing the problem.
  • First you need to identify a problem and diagnose why it has occurred. Methods to fix the problem are then proposed and implemented and the outcomes are measured (“how much improvement have we made?”)
  • Audits are good to answer simple questions.
  • Usually involves a medical record review, answering questions such as “How many patients received appropriate venous thromboembolism prophylaxis?” or “How many patients with sepsis received antibiotics within one hour?”
  • Audits are best to be a part of a team project which leads to change or improvement.
  • Start by identifying an issue you feel is a problem and is important to you. What question would you like to answer? What evidence is required to answer your question?
  • The audit itself is sometimes the easiest part of the quality improvement cycle – an excellent way to get involved is if a team is already working on an issue and an audit is required as part of that process.
  • Consider the problem you are trying to solve and approach the appropriate supervisor. This may be their immediate supervisor or consultant.
  • An audit is most useful when you know that it will have implications for practice in the department and this requires the support of senior staff.
  • The idea of an audit is to create a baseline, then have an improvement program, then repeat the audit to see if there has been improvement. This is the idea of a quality improvement cycle.
  • Publication is very important once you have completed a quality improvement cycle. The issues we face on the wards are the same in different hospitals around the world.
  • There are an emerging number of places to publish quality improvement cycles, for example, BMJ Quality and Safety.
  • Many conferences and colleges are now supporting improvement work. A poster for presentation at a conference is an excellent way to present quality improvement cycle findings.
  • Whether ethics approval is required would depend on the nature of your research and where it is conducted. Your hospital may have a process to approve quality improvement projects so they can fast-track ethics approval – discuss this with your clinical governance unit, and service improvement units.
  • Making our care better and safer for patients – you really can save lives.
  • Improving the workplace for staff.
  • Improving your quality and safety skills.
  • Learning how to change things – we all notice problems, but learning how to do something about problems is a very valuable professional skill.

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Tags: #audit,#BMJ Quality and Safety,#clinical governance,#improvement program,#medical record review,#patient safety,#quality and safety,#quality improvement cycle,#quality patient care

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