Quality improvement methods in child health — formative SAQs

SAQ 1 — Designing a paediatric QI project (10 marks)

A neonatal unit wants to reduce the proportion of infants receiving antibiotics beyond 48 hours when no infection is proven. The current rate is 40%. The registrar asks you how to design the project. [1] [8]

Questions

1. State the Model for Improvement and write a specific, measurable, time-bound aim for this problem. (3 marks) [1]
2. Describe the balanced set of measures you would track, defining outcome, process and balancing measures for this project. (4 marks) [1]
3. Outline how you would test a change idea using a PDSA cycle before any unit-wide rollout. (3 marks) [2] [8]

Model answer

Model and aim (3). The Model for Improvement asks three questions — what are we trying to accomplish, how will we know a change is an improvement, and what change can we test — then runs Plan-Do-Study-Act cycles. Aim: reduce the proportion of infants on our unit receiving antibiotics beyond 48 hours without a proven infection from 40% to 20% within 6 months. [1]

Balanced measures (4). Outcome: proportion of infants with antibiotics continued beyond 48 hours without proven infection. Process: proportion of antibiotic courses with a documented 48-hour stop-or-review decision. Balancing: proportion of infants with a subsequently proven infection who had antibiotics stopped at 48 hours (a re-start rate, to detect under-treatment), plus length of stay. [1]

PDSA test (3). Plan: test a 48-hour antibiotic stop-review checklist on one team, one shift, defining the data to collect. Do: run the test and record what happens. Study: compare the result to the prediction and gather staff and family feedback. Act: adopt, adapt or abandon — then scale to more shifts if successful before any unit-wide rollout. [2] [8]