Dr Melanie Tan (ST7)
- Quality Improvement
These posts were initially developed in 2011 in order to retain the number of registrar posts and I was one of the first people in post. At the time I needed to develop my ‘back page’ and since the post had no description, I figured it would be a great way to ensure I get all the boxes ticked. The other trainee had gone on maternity leave, so I found myself leading on the development of the post. I spent six months officially in post and then another 6 months behind the scenes.
Paula Meale (MSc research nurse), who works with Dan Martin (ITU consultant), had been appointed as the frontline lead to troubleshoot the implementation of the existing Enhanced Recovery Programme (led by Jon Read, Anaesthetic consultant) and I was sent to meet her in the first instance.
My first role was to do quite a large audit to evaluate the existing programme and find areas to troubleshoot. It quickly became apparent that this was as part of the Quality Improvement Programme (QIPP) for the Royal Free Hospital. I was asked to present my audit results at a QIPP management meeting where I learnt what the Trust workstreams for improvement were. This was a major eye opener because I’d never been to a meeting with managers before. We developed a consensus document (a postoperative care pathway agreed by all the departmental surgical consultants) which helped to empower the nursing staff to carry out Enhanced Recovery activities such as automatic removal of catheters & NG tubes as well as helping to write the postoperative pain protocol and help with pharmacy procurement problems.
Whilst I was in post both the Enhanced Recovery Fellows managed to get onto a leadership & management course and there was the thought that this should be formalised so that it is part of the 6 month Fellowship programme.
Paula and I also set up Enhanced Recovery MDT meetings, by this time I was spending many extra hours on developing the Enhanced Recovery programme in various facets and I approached Adrian England to allocate some dedicated time off the rota. This hasn’t been formalised as a fixed session due to rota limitations but there is an agreement that the rota coordinator will try and allocate the necessary time if the Fellow requests it in advance of writing the weekly rota. I used the time mainly to get to various meetings.
I started education sessions for the juniors on the ward, an MDT teaching ward round and Joint School for patients as well as organising 2 cross-hospital (RFH & Whittington) study days where we had a series of speakers from various specialities. We also got the Doppler representatives in to teach the anaesthetic staff on new protocols and developments and as a result we were often allocated to the colorectal lists in order to facilitate this and audit data collection.
Ultimately this fellowship ticked a lot of boxes for me, it has a lot of scope for improvement and it did require a fair amount of initiative. No one minded me going to all these activities, but I had to be proactive in asking to attend. I enjoyed it very much and it taught me a lot about management and politics of the hospital.
What is QIPP?
QIPP stands for Quality Innovation Productivity & Prevention. It is a large scale Department of Health initiative to save the NHS up to £20 billion in efficiency savings by 2014/15. It is a broad policy agenda incorporating many national workstreams aimed at improving commissioning (purchasing) of care for patients to improving organisational efficiency
What is Enhanced Recovery?
A multimodal strategy to improve the perioperative care pathway for primarily colorectal patients but can be extended to other specialities. The process has been shown to result in savings via bedstay days as well as reducing morbidity & mortality. There is currently a National agenda to implement Enhanced Recovery programmes across all colorectal units.