Case Studies

Across the years we’ve seen some fantastic QI projects that foundation year doctors have undertaken. We’ve selected a few QIPs that have been submitted to our conference by foundation doctors to showcase their excellent work, as well as to demonstrate excellent use of QI methodology.

In this section, we’ll discuss what we liked about these projects, as well as asking more in-depth questions from the author about their projects.  

Gary Jevons (TIPS QI Chair)

This was a fantastic project, which demonstrated how general practice is an ideal place to conduct QI work, not least because of the wealth of readily available information that can be drawn from electronic note systems. 

This project showed excellent use of many aspects of QI methodology, most notably by inclusion of a “run chart”. Baseline data was collected prior to implementation of PDSA cycles, and it was established that 25% of patients with symptoms that were suggestive of ovarian and/or colorectal cancer received safety netting advice. A “baseline” is derived from the median of the data points prior to any intervention to gain an understanding of normal variation. As data within QI tends to be positively or negatively skewed, the median is the “best” average to use. After PDSA cycles including practice meetings, developing a safety netting text for patients, creation of a safety net shortcut code; the authors showed a dramatic improvement in their outcome measure, improving to 75%. Remember that when 6 points of your run chart are above (or below) the baseline median, this indicates a “shift” or special cause variation, as this suggests that the change in the outcome measure has a p value of less than 0.05 (p<0.05). 

Roz Whitaker (author)

Why did you choose this QI topic?

We wanted to find a QI project that included acute oncology within a GP practice, which led us onto develop a project on improving cancer safety netting within primary care. 

Did you encounter any struggles? How did you overcome these?

Implementing the intervention was challenging, due to varying practices of safety netting and documentation between clinicians, as well as time pressures. It was important to listen to these views, experiences and priorities of our GP colleagues, and design interventions that reflected this. Regular reminders were needed, alongside multiple teaching sessions to make sure we reached all clinicians working in the practice.

Did you find the TIPS QI teaching sessions useful when carrying out your project?

We did some initial reading around QI methodology and design, but we had specific questions around run charts and balancing measures. We attended a virtual TIPS QI session which was very helpful. We got to ask our questions, and talk through the challenges that we were facing with our QI project.