Just Say Yes, Please

Published: 10 Aug 2020

At this time last year, to mark the arrival of the next cohort of junior doctors arriving or turning round, I wrote a blog entitled Just Say No. This was to suggest that, on induction with your new educational supervisor, if they suggested getting out 20 sets of case notes and doing an “audit”, that this offer was declined and a more productive quality improvement activity pursued (with the caveat that if the supervisor was to be intimately involved in the notes review, that that would be acceptable).

Now we have had COVID-19 and the world has turned upside down.

I would suggest that for all of our junior doctors in whatever situation, secondary care, primary care, mental health and public health, there are lots of opportunities for doing an audit that would likely be useful in improving the quality of the service that we offer patients.

Guidelines: something for everyone

I would refer you to NICE’s webpage dealing with COVID-19. Here they have rapidly produced 41 sets of guidelines covering many relevant areas of healthcare. They go from specialist areas such as renal dialysis, chemotherapy and acute myocardial injury to the treatment of pneumonia in the community and in hospital, to overall antibiotic therapy, to end of life care in the community. There is virtually something for every junior to look at.

In the situation where there may be nothing relevant, please look at your relevant college or society website and there will be something there.

Finally, all healthcare organisations are producing their own very important local guidelines to protect staff and patients, both in the community and in institutions. Here you will find very useful guidelines.

Answer a question that needs answering

Why not talk to your education supervisor and find out where the tensions lie. Go to the other staff groups and get their opinions. (I am not talking about having meetings! No, go to the areas where staff relax and talk). Find the most relevant guideline and do something prospectively. Enrol the other professionals and if it seems to be growing make sure you have enough people to complete in the time you are there. You could do something with the next colleague rotating in so that there is continuity. If the audit is worthwhile, with buy in, then it will have its own life. When such an audit is answering a question that colleagues agree need answering, then it will survive.

Remember that the national clinical audits are there. The intensive care audits (adult and paediatric) have been running through the pandemic and are a resource with a large volume of assured data that can be used. Other audits such as the cardiac audits and trauma (TARN) are also there as a resource.

You can see that I have been plugging prospective audit as there will be multiple historical reviews of how we did or did not do such and such. Let us leave that and concentrate on the here and now. Much more exciting for you to work on such a topic where what you find can be quickly used to improve what we do. Then you will fully understand the power of proper clinical audit to improve services. That has been one of the most powerful messages from COVID-19 which has been to unleash the power of clinicians to see a problem and go after it to improve it.

Danny Keenan
HQIP Medical Director