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
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.
Sample QIPS - The following anonymised QIPs are published with the kind permission of the candidates:
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.
- RCEM Quality Improvement Guide (June 2020) essential reading includes:
- Practical advice (pages 38-41)
- Suggested timescales (page 49)
- Assessing a QIP (page 44)
Useful QI resources
Introduction to QI principles and methods
Data and analysis
Courses, further learning and local initiatives
Websites for QI organisations
If you would like to suggest a resource to be featured on this page, please contact email@example.com.