News BMJ Group Awards: Best Quality Improvement category

Teams vie to find ways to improve care of patients

BMJ 2010; 340 doi: (Published 13 January 2010) Cite this as: BMJ 2010;340:c140
  1. Jane Smith,
  2. Fiona Moss
  1. 1BMJ
  2. 2London Deanery

    This year’s 28 submissions for the Best Quality Improvement award in the 2010 BMJ Group Awards cover a wide spread of specialties and services from virtually all geographical areas of the United Kingdom, with many good examples of improvement in the effectiveness and safety of patient care.

    In the end the shortlist of four emerged easily. Many entries had ruled themselves out because they didn’t meet the criterion of sustaining their change for at least 18 months; we hope that those applicants will apply again next year.

    The shortlisted projects come from a primary care trust, a national specialty society, a combined hyperacute and stroke rehabilitation unit, and a hospital team.

    The primary care trust NHS County Durham has seen an average 8% rise in its prescribing expenditure since the late 1990s, and in 2007 its drug and therapeutics committee set a series of targets for drugs management within the Quality Outcomes Framework. Each of the 85 practices in its area had to choose three targets (preferably where their performance needed improving), and the trust’s pharmaceutical advisers then worked with each practice to help them audit and implement their improvements in prescribing.

    The improvements included a fall in total use of non-steroidal anti-inflammatory drugs by 6.2% in Darlington and of 4.2% in County Durham (compared with a national fall of 2.5% over the same period); similarly the use of diclofenac fell, respectively, by 23% and 17% (compared with 7% nationally).

    The Society for Cardiothoracic Surgery in Great Britain and Ireland has pioneered the collection of accurate data on outcomes among patients undergoing surgery. It has put information on mortality rates in the public domain, developed risk stratification, adopted an approach to handling surgeons and units with outcomes lying outside the expected statistical boundaries, and reached a position where every surgeon member of the society completes and submits a detailed dataset for each patient undergoing cardiac surgery.

    Despite the average age and the prevalence of comorbidities rising among these patients, mortality rates have fallen steadily. And among patients aged under 70 undergoing elective coronary artery bypass grafting the death rate is now less than 1%.

    The stroke unit and facilitated discharge team at Northumbria Healthcare NHS Foundation Trust redesigned its stroke service—which was already strong in rehabilitation—to ensure the rapid transfer of all people with suspected stroke to a specialist service offering immediate hyperacute assessment, urgent brain imaging, and 24 hour access to thrombolysis. To do this the team redesigned the service and created a single stroke unit on one site combining acute care, rehabilitation beds, and early supported discharge.

    From September 2007 to August 2009 the percentage of patients receiving thrombolysis rose from 2.7% to 7.7%, and rates of institutionalisation have remained consistently low at less than 5%. The redesigned service has dramatically improved clinical care, halved lengths of stay, and saved £500 000 (€560 000; $800 000). The unit is now in the top 5% of trusts in the National Sentinel Audit of Stroke.

    A team in Abertawe Bro Morgannwg University NHS Trust, Swansea, believed that virtually all pressure ulcers that develop in hospitals were preventable if “the extensive evidence base of knowledge of causation and prevention could be translated into action on the wards in a sustainable way.” So, through using PDSA (“plan, do, study, act”) cycles on a pilot ward, they ensured compliance with Waterlow criteria for ulcers and nutritional risk tools and that a “SKIN bundle” (Surface, Keeping the patient moving, managing Incontinence, and optimising Nutrition) was used for patients at risk of ulcers.

    Their project, part of the Welsh “1000 Lives” patient safety campaign, aimed to halve the incidence of pressure ulcers, but over the first 19 months no pressure ulcers occurred on the pilot ward, and similarly good results have been achieved as the project has been rolled out across other wards in their large university hospital. The measure they use—number of days since an ulcer last developed on the ward—“sends a powerful message to staff, managers, and patients alike that pressure ulcers are critical clinical incidents, not an expected part of inpatient care,” the team says.

    Now it is down to the judges. They include last year’s winner, Peter Garrett, along with Graham Teasdale, Helen Bevan, and Jonathon Gray. They will be looking for the project that best combines a clear strategy for improvement with measurable benefits for patients, taking account of the linkage between organisational change and clinical benefit, novelty of approach, and overcoming barriers to change.


    Cite this as: BMJ 2010;340:c140


    • The Best Quality Improvement category in the BMJ Group Awards is sponsored by the Health Foundation and the Department of Health for England. For more information go to

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