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Quality Improvement: the Way Forward……

As Registrar in Anaesthetics I have undertaken many an audit including completing a few cycles along the way. It was something I had to do as part of my training curriculum, however the audit process always left me feeling that nothing had really changed, for example “we looked at the number of cases of X”, It was this between February and March, ” plan - we will re audit again to see if it has improved.”

It was only after my experience as a Welsh Clinical Leadership Training Fellow that my perspective changed. The Welsh Clinical Leadership Training Fellowship (WCLTF) programme is run by the HEIW in association with NHS Wales, the Welsh Government and other health related organisations in Wales. It is offered to all Doctors, Dentists and now pharmacists a year out of training with the aim to develop high quality clinical leaders for the future NHS. The WCLTF programme uniquely offers fellows the opportunity to lead a quality improvement project, supported by a by a structured, accredited, training programme run by Academi Wales. I feel strongly that clinicians and frontline staff are best placed to know what changes are needed to improve patient care, however I appreciate that it is a huge challenge in how to accomplish this a on significant scale.

The Quality improvement project that I was involved in was OBSCymru, the Obstetric Bleeding Strategy for Wales, which is a collaborative Quality Improvement Project (QIP) attempting to establish a leading approach to PPH care in Wales with the aim of reducing variation in maternal morbidity and improving outcomes associated with postpartum haemorrhage (PPH). . OBS Cymru aims to achieve this through universal risk assessment, blood loss measurement, multidisciplinary team (MDT) working and case review, and individually guided blood product management using viscoelastometric point-of-care testing (VE-POCT).

The key themes the and lessons from this project were;

· Important to pick a measurement that will be monitored sequentially over time to assess if your quality improvement intervention has had any kind of impact. It our project we focused on blood transfusion and followed the trends before our OBS Cymru intervention and how it changed after. Spoiler: we showed a large reduction in blood product usage nationally and in unit in BCUHB transfusion of Red Cells fell from 168 to 79 units a reduction of 53%. Transfusion of fresh frozen plasma has fallen from 31 to 2 units a reduction of 98%.

· Changing practice takes time and effort. For a project to succeed, there has to be engagement from all those involved to move in a new and hopefully better direction to improve patient care.

· Listen to those involved especially patients to see how what you are doing can be improved.

· Quality improvement requires a continuous approach to changing clinical practice and care, with the use of “Plan, Do, Study, Act” (PDSA) cycles to constantly refine the project.

Being involved in this quality improvement project has provided network opportunities within the local and national quality improvement community to see how knowledge and good practice can be shared. Through all the hard work by the delivery suite teams in BCU and throughout Wales OBS Cymru has won multiple national awards. I have come to realise that no project is ever perfect when it starts but by carrying out PDSA cycles it can be refined and hopefully show a positive change for patients. I have found the BCUQI team and conference a great resource to improve my own professional development and in the end improve overall care for patients within BCU.


Dr Kevin Kelly MPharm MBChB (Hons) FRCA

Anaesthetics ST5 Wrexham Maelor Hospital

Welsh Clinical Leadership Fellow Alumnus- OBS Cymru

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