IGNITE! MagIQ on improving quality

Matthew BridgeNick Lown

Introduction

1 Who are we?

2 Merseyside Anaesthetic Trainees Audit Activity Survey

3 Forming MAGIQ

4 Mersey Intubation Checklist Project

Who are we?

Who are we?

Lesson 1

Just get started

Mersey Anaesthetic Trainees’ Audit Activity Survey

Experiences

Best practice Impact

Audit Activity Survey

•BarriersTimeCriticism

•ResourcesAccess to influence

•Project selection•Audit standard•Collaboration•Feedback

•Intervention•Impact if reaudited

•Time invested

Develop survey items

Draft surveys

Pilot testing

Medline search 21 sources identified13 key sources Cochrane review,

HQIP, NICE, RCOA guidance, peer reviewed articles

Surv

ey d

evel

opm

ent


•Recruited survey representatives •11 sites across the Mersey Deanery•100 questionnaires distributed•Total responses = 69•Total number of audits >215


Number of trainees, n=69

Estimated hours worked per audit

0-5hrs

6-10hrs

11-15hrs

16-20hrs

21+ hrs

0 5 10 15 20 25

111718

21

Projects reaudited

ANDrecognisable

change in practice

16%Estimated >1000+ hours total !


Lesson 2

People aren’t used to change

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”

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

Lesson 3

Seek out help and support

•Individuals with an interest in QI•Audit departments•National groups

Forming MAGIQ

Group manual

Mersey Anaesthetic Group for Improving Quality

Websitewww.merseymagiq.com

Forming MAGIQ

Forming MAGIQ

Lesson 4

Persevere, show people that you’re making an effort, be meticulous and dedicated

Mersey Anaesthetic Group for Improving Quality

Forming MAGIQ

Intubation Checklist


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


Change Processes

1 Multiple, rapid audit and feedback cycles

2 Social norms

Can we change behaviour?

Influence not imposition

Local emphasis1. 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

Context1. Alder Hey2. Aintree Theatres3. Aintree ICU4. Walton Centre5. Royal Liverpool

Theatres

6. Royal Liverpool ICU

7. Chester8. Whiston9. Warrington10.Arrowe Park11.Liverpool Heart

& Chest

Hospital Sites

1. Trainee Anaesthetists / ICM doctors2. Consultant / non-career grade

Anaesthetists / ICM doctors3. ODPs4. ITU nurses

Main staff Groups1. Intensive Care Units2. A&E departments3. Hospital wards4. Radiology departments5. Anywhere!

Locations

Lesson 5

Information Governance is probably not as bad as you think

Data Collection

Accident and Emergency


Data Collection


Data Collection

Data Collection

?

Data Collection

Data Collection

Feedback

Lesson 6

The technology is out there (and affordable)

ResultsHospital performance by week

Overall Checklist Use

Week 151%

Week 287%

n=319

Results

Hospital performance at beginning vs end project

8/11 hospitals demonstrated an increase in intubation checklist use

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

Future Directions

Questions?

www.merseymagiq.com@mersey_magiq

Healthcare

IGNITE! MagIQ on improving quality