The AAA QIP aims to encourage the use of best practice processes (see AAA Care Pathway) and protocols that have been shown to reduce AAA mortality. Vascular Units throughout the UK have implemented these into practice by adapting these to suit local needs.
We have worked within regions to hold ongoing regional events introducing best practice AAA protocols into practice. Template protocol documents have been discussed and reviewed through group sessions with suggestions of region specific requirements. Meetings have then been followed by Regional Action Plans where Trusts/teams carry out ONE intervention to test an element of the care pathway/protocol using quality improvement methodology. Once the protocols have been tested and proven to work in practice a follow up meeting is held to agree the final standards in the care pathway and specific protocols that are to be adopted as the standard for that region. The ultimate aim is to develop a standardised AAA Care Pathway for each region.
Changes have been introduced through local testing to increase ownership of the protocols and to improve implementation into standard practice.
Key Elements of the Regional Action Plan Process:
Participation from all key stakeholders; vascular surgeons, radiologists, anaesthetists, nurses, managers, patients, C&S Networks and SHA/Commissioning teams.
Share current practice and agree ideal best practice for the region
Improvement work over time
Trusts/teams test ONE best practice protocol/intervention
Local leads within each unit to drive QIP interventions
Follow up meetings to report back on progress, share outcomes and learning
AAAQIP team to provide ongoing support, track data contribution and outcomes
What is involved?
The process begins with an organised regional event. Short presentations have been delivered on national audit, feedback on AAA and carotid data for the region and demonstrations on quality improvement methodology. Group sessions discussing the AAA care pathway then follow. The structure of the day should be organised depending on the region's requirements.
We aim to cover each element of the AAA care pathway. These include:
1. Patient Consultation: AAA patient information leaflets and consent forms
2. The decision to treat: Preoperative screening and risk scoring.
3. MDT: Who should be involved in the decision to treat?
4. Intra-operative care.
5. Post operative and discharge care.
6. Measurement of outcomes and patient experience.
Attendees have been divided into groups to discuss each element of the care pathway as well as the best practice protocols involved. Groups rotated to allow all delegates to provide input on each element of care. Salient themes and issues were then fed back by group leads. Based on the feedback, Trusts/teams volunteered to test one element of the care pathway. The day ended by summarising discussions and agreeing an action plan for implementation. The teams went away and worked together to carry out quality improvement interventions on their chosen care pathway element over a 3 month period with the aim of providing feedback on implementation at a follow up meeting.
Attendees were required to:
1. Bring your team to enable you to effectively plan your local implementation strategy.
2. Share current practice through group discussions and agree best practice quality standards.
3. Volunteer to pilot ONE best practice protocol within your unit.
4. Identify a champion/leader within your unit to lead the QI intervention work.
The benefits in participating?
Regional action plans work to bring clincians involved in the care of AAA patients together. Experiences are shared based on local processes thus protocols can be adopted with the optimal changes to suit the region. This will act to standardise vascular practice throughout a region and improve patient safety.