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Paeds Vivasprofessional-practice-and-evidence

Paeds Vivas · professional-practice-and-evidence

Quality improvement methods in child health — branching viva

Viva on the Model for Improvement, aim and measure design, PDSA testing, run-chart interpretation, collaboratives, and appraising the strength of QI evidence in a child-health project.

branching clinical structured oral4 min readVerification in progress

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
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Study tools

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Ward: a neonatal unit wants to reduce unnecessary antibiotic exposure; the current rate of infants receiving antibiotics beyond 48 hours without proven infection is 40%; a registrar has been asked to lead a project and has proposed 'educating everyone and reauditing in a year'; the examiner wants to know how you would actually do it.

Opening (candidate)

My first job is to reframe this from a poster-and-reaudit into a genuine quality improvement project. I would use the Model for Improvement: define a specific, measurable, time-bound aim; choose a balanced set of outcome, process and balancing measures; establish a reliable baseline run chart; then test change ideas with small PDSA cycles before scaling anything. I would secure a senior sponsor and protected time, build a multidisciplinary team including nursing, pharmacy and a family partner, and disaggregate the data by subgroup so an equity gap does not hide behind an improving average. [1] [8]

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References7ShowHide
  1. [1]Berwick DM A primer on leading the improvement of systems. BMJ, 1996.PMID 8595340
  2. [2]Berwick DM Developing and testing changes in delivery of care. Annals of internal medicine, 1998.PMID 9537939
  3. [5]Horbar JD, Rogowski J, Plsek PE, Delmore P Collaborative quality improvement for neonatal intensive care. NIC/Q Project Investigators of the Vermont Oxford Network. Pediatrics, 2001.PMID 11134428
  4. [8]Taylor MJ, McNicholas C, Nicolay C, Darzi A Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ quality & safety, 2014.PMID 24025320
  5. [9]Thor J, Lundberg J, Ask J, Olsson J Application of statistical process control in healthcare improvement: systematic review. Quality & safety in health care, 2007.PMID 17913782
  6. [10]Ogrinc G, Armstrong GE, Dolansky MA, Singh MK SQUIRE-EDU (Standards for QUality Improvement Reporting Excellence in Education): Publication Guidelines for Educational Improvement. Academic medicine, 2019.PMID 30998575
  7. [13]Dukhovny D, Buus-Frank ME, Edwards EM, Ho T A Collaborative Multicenter QI Initiative to Improve Antibiotic Stewardship in Newborns. Pediatrics, 2019.PMID 31676682
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