see also: [[Writing a guideline]], [[Clinical Governance]] see : [Dunn - Quality Improvement](x-devonthink-item://C17B7960-143D-4C81-B8D3-042AE2D98300) [Safer care victoria - A systems-focused framework for morbidity and mortality meetings](https://www.safercare.vic.gov.au/sites/default/files/2024-08/SCV%20systems-focused%20Morbidity%20and%20Mortality%20Framework%20FINAL.pdf) - [devonthink link](x-devonthink-item://FF51E0AA-975C-4D5A-B2A0-6F78FFA978A1) **credentialing** - formal process to recognise and verify and individuals qualifications to asses their capacity to safely perform a task **benchmarking** -compares performance with others with the use of best practice as a marker for improvement # PDSA - **plan** - develop a plan to test the change - **do** - carry out the test - **study** - observe and learn from the consequences - **act** - determine which modifications are needed from the test ## SMART specific measurable attainable relevant timely # Quality indicators - divided into structure, process, and outcome measures **Structure indicators** provide information about the organization’s environment such as human resources, physical resources, physical layout and organisational framework. **Process indicators** measure the provision of care, supplying quantitative data regarding the effectiveness of policies, procedures and systems. **Outcome indicators** refer to the result of care, and provide quantitative data related to the outcomes of performance, typically including mortality, morbidity and quality of life a. System (protocols, guidelines, inadequate supervision) b. Process (equipment, indication, alternative treatments) C. Individual factors (support doctor, assess reasons such as fatigue) ## Quality indicators in ED and KPIs - NEAT - ATS compliance - time to PCI - time to analgesia - time to abx in sepsis, febrile neutropenia, febrile neonate - waiting time by ATS - unplanned re-attendance rates - DNW rates - Access block % (admitted pts in ED > 24 hours) - Missed fractures - Staff retention - [[Short stay units|SSU]] admits >24h # Caveats of QI ![[Pasted image 20250302003258.png]] ## Differences from research - aims to improve practice, not gain new knowledge - adopts current knowledge - data collection - not blinded - just "good enough" to act on **Research vs. Audit** - research: what is the "right" thing to do? - audit: are we doing the right thing? ![[Pasted image 20250625103224.png]] ## Limitations of QI activities - measuring the effect of an intervention in one quality dimension without measuring its effect on other dimensions - not a long enough period of reinforcement and monitoring to make improvements of interventions permanent - short term gains are lost with time - strategies resulting in transient gains are marketed as "the solution" - easily measured things tend to be measured instead of important things - processes are more commonly studied than actual patient outcomes # Example question "You are a consultant with your regional retrieval service, a review of the standard training, equipment and drugs carried by retrievalists has been recommended. As part of this process, you have been asked to draw up a protocol for rapid sequence induction of adult trauma patients. State 6 steps to describe the process you would employ to develop and implement this protocol (6 marks)" **answer** - Planning: meet with stakeholders (retrievalists, paramedics, receiving trauma units) and identify issues and concerns, discuss current practices - review: review current practices and audit, literature review of current practices - draft protocol: define scope, rationale, indications, equipment, medications  - solicit feedback: circulate draft to stakeholders, make revisions - implement protocol: distribute protocol - study and quality improvement cycle: audit outcomes, solicit feedback, implement changes as needed in “Plan, Do, Study, Act” cycle