IGNITE! MagIQ on improving quality
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1. The document describes a survey of anaesthetic trainees in Merseyside that found they collectively spent over 1000 hours on audits but only 16% resulted in recognizable practice changes. 2. It then outlines the formation of MAGIQ (Mersey Anaesthetic Group for Improving Quality) to help trainees collaborate on quality improvement projects and overcome barriers like lack of time, resources and support. 3. One such project was a Mersey-wide initiative to increase the use of pre-intubation checklists, which through rapid audit and feedback across 11 hospitals was able to increase checklist use from 51% to 87% over 8 weeks.
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IGNITE! MagIQ on improving quality
- 2. Introduction 1 Who are we? 2 Merseyside Anaesthetic Trainees Audit Activity Survey 3 Forming MAGIQ 4 Mersey Intubation Checklist Project
- 3. Who are we?
- 4. Who are we?
- 6. Mersey Anaesthetic Trainees’ Audit Activity Survey Experiences Best practice Impact Audit Activity Survey •Barriers Time Criticism •Resources Access to influence •Project selection •Audit standard •Collaboration •Feedback •Intervention •Impact if reaudited •Time invested
- 7. Develop survey items Draft surveys Pilot testing Medline search 21 sources identified 13 key sources Cochrane review, HQIP, NICE, RCOA guidance, peer reviewed articles SurveydevelopmentAudit Activity Survey
- 8. •Recruited survey representatives •11 sites across the Mersey Deanery •100 questionnaires distributed •Total responses = 69 •Total number of audits >215 Audit Activity Survey
- 9. Number of trainees, n=69 Estimated hours worked per audit 11 17 18 21 0 10 20 0-5hrs 6-10hrs 11-15hrs 16-20hrs 21+ hrs Projects reaudited AND recognisable change in practice 16% Estimated >1000+ hours total ! Audit Activity Survey
- 10. Lesson 2 People aren’t used to change
- 11. Forming MAGIQ •“This has failed before why should it work this time?” •“Going for consultant jobs are we?” •“Pyramid scheme!” •“What’s in it for me?” •“Even if you do your project and your data shows an improvement in practice you won’t have changed practice really”
- 12. 1989 white paper established requirement for clinicians to participate in audit 2010 RCoA curriculum – “Can lead teams to introduce a clincal quality improvement” Forming MAGIQ
- 13. Lesson 3 Seek out help and support
- 14. •Individuals with an interest in QI •Audit departments •National groups Forming MAGIQ
- 15. Group manual Mersey Anaesthetic Group for Improving Quality Website www.merseymagiq.com Forming MAGIQ
- 16. Forming MAGIQ
- 17. Lesson 4 Persevere, show people that you’re making an effort, be meticulous and dedicated
- 18. Mersey Anaesthetic Group for Improving Quality Forming MAGIQ
- 21. Aims • Achieve >90% use of pre-intubation checklists for emergency out of theatre intubations within the 8 week period of the project. • Increase the acceptance of pre-intubation checklists for emergency out of theatre intubations Intubation Checklist
- 22. Change Processes 1 Multiple, rapid audit and feedback cycles 2 Social norms Can we change behaviour? Influence not imposition
- 23. Local emphasis 1. Rapid site specific audit and feedback cycles 2. Promote local ownership of the checklists 3. Identify barriers to checklist use and promote individualised solutions 1. Inter-site benchmarking 2. Sharing of solutions and best practice Central emphasis Change Processes
- 24. Context 1. Alder Hey 2. Aintree Theatres 3. Aintree ICU 4. Walton Centre 5. Royal Liverpool Theatres 6. Royal Liverpool ICU 7. Chester 8. Whiston 9. Warrington 10. Arrowe Park 11. Liverpool Heart & Chest Hospital Sites 1. Trainee Anaesthetists / ICM doctors 2. Consultant / non-career grade Anaesthetists / ICM doctors 3. ODPs 4. ITU nurses Main staff Groups 1. Intensive Care Units 2. A&E departments 3. Hospital wards 4. Radiology departments 5. Anywhere! Locations
- 25. Lesson 5 Information Governance is probably not as bad as you think
- 29. Data Collection
- 31. Data Collection
- 32. Feedback
- 33. Lesson 6 The technology is out there (and affordable)
- 34. Results Hospital performance by week Overall Checklist Use Week 1 51% Week 2 87% n=319
- 35. Results Hospital performance at beginning vs end project 8/11 hospitals demonstrated an increase in intubation checklist use
- 36. Summary •Rapid audit & feedback and social norms can increase the use of checklists for emergency intubations •Region wide, trainee led Quality Improvement is feasible and effective
Editor's Notes
- Trainee audits, background, how we investigated, issues that we found Developed a solution in the form of a trainee RAG Sales pitch!
- Bunch of amateurs
- Bunch of amateurs!
- Bunch of amateurs!
- 20 items questionnaire More than we can discuss tonight Emphasis on the QI / how impactful? part of audit Best practice further split into audit and feedback methods 4 main domains – best practice split into to 2 to further develop the feeback
- Trainee survey as unlikely to get info we wanted directly from audit departments Good surveys are hard! External validity – for generalisability Pilot testing – testing the survey with the target study group External validity – eg we wanted these results to be generalisable Response process validity – assess that respondents are interpreting things the same way as the researcher – qualitative interview Multiple rewrites
- Paper has 20% higher return rate than online – shih Using the online decision tool from the health research authority – no ethical clearance required
- Impact on trainees is clear Time is biggest limiting factor Impact on care – gold standard = only 11 trainees Huge wasted resource Does this mean actually all audits are very effective Unlikely , selection bias more likely The bottom line is the gold standard
- Old message = Conventional audit is a poor method of improving patient quality New message = people aren’t used to change, low expectation
- Culture of the yearly audit tick box for ARCP
- Balance out the negative voices Find
- Summarise
- Balance out the negative voices Find
- Share ideas & expertise Continuity of project Harnessing enthusiasm – 7pm on Wednesday – people are having an audit meeting
- Augmenting local change Using pre-existing audit structures
- Balance out the negative voices Find
- Thank the audience