Quality Improvement Resources

This page collates some of the most useful quality improvement resources for ED staff, including trainees and supervisors preparing for exams.

What is Quality Improvement?

“The conception of improvement finally reached as a result of the review was to define improvement as better patient experience and outcomes achieved through changing provider behaviour and organisation through using a systematic change method and strategies.” (Dr John Øvretveit, Does Improving Quality Save Money? Sept 2009).

What is Quality Care?

The Institute of Medicine (IoM) defines quality care as: safe, effective, patient-centered, timely, efficient and equitable. Read more about these six domains of quality in Crossing the Quality Chasm (IoM, March 2001).

Featured resources for quality improvement in the ED

RCEM Quality Improvement Guide (September 2022)
National QIPs

Resources for trainees preparing for FRCEM QIP examination

It can be a little daunting and confusing trying to decide what problem needs a quality improvement project. The following principles should guide the choice of a QIP:

The problem should be important to both you and your patients.
The project should aim, explicitly, to improve the quality of care for patients.
Projects that aim to save money or meet performance targets are important, but not necessarily quality improvement, though a QIP might lead to savings.
Your own interest is vital to sustain the project and enthuse others.
You need to ensure that this is not duplicating other QI work in your department, there should be a consultant in each department who maintains a log of all the quality improvement activity.
Discussing the aim of your project with a few appropriate patients can be extremely useful.
It can be helpful looking through some recent complaint letters to see if there are any particular recurring themes.

Effective projects start with very focused problems, it is tempting to be overly ambitious at the start of a project. Truly effective change starts incrementally with small, achievable goals.

Trainees are encouraged to begin their QIP early in their HST training such as ST3/4 to reduce pressures later on.

Resources

Sample QIPS – The following anonymised QIPs are published with the kind permission of the candidates:

Successful QIP on reducing the referral rates of paediatric patients to plastic surgery (Spring 2017)
Successful QIP on management of fractured neck of femurs in the ED (Spring 2018)
Unsuccessful QIP and subsequent successful QIP
Marking commentary
Trainees and Healthcare organisations Roles and responsibilities in quality improvement and audit (Nov 2018)

Please check the FRCEM final examination page for further information.

Resources for supervisors

Whilst a good knowledge of QI is useful for all ED staff, below are specific resources you will need to supervise trainees in choosing projects and completing a high quality QIP.

Trainees should be encouraged to practice small QI projects during foundation and core training, either as collaborators or project leads. It is generally accepted that trainees do better if they choose their own subject areas as this helps maintain interest. Regular review of a trainee’s project is important.