QI vs Audit
An audit measures current practice against a standard. A quality improvement project (QIP) actively implements and tests a change. Both are valuable, but QIPs increasingly score higher in training applications because they demonstrate leadership and change management skills.
The PDSA Cycle
The Plan-Do-Study-Act cycle is the most widely recognised QI framework internationally — used across NHS, VA, IHI and virtually all postgraduate training programmes.
Plan
Define the problem clearly. What are you trying to improve? Who is affected? What change will you test? Set a specific, measurable aim (e.g. "Reduce DVT prophylaxis omission rate from 35% to less than 10% within 8 weeks").
Do
Implement your change on a small scale first. A ward, a team, a clinic. Collect baseline and post-intervention data simultaneously.
Study
Analyse the results. Did the change work? What was the effect size? Were there unintended consequences?
Act
Adopt, adapt or abandon the change based on your findings. Multiple PDSA cycles are better than one — each iteration strengthens the evidence.
Example QIP Projects
Project 1: VTE Prophylaxis Checklist
Problem: 35% of patients not receiving appropriate VTE prophylaxis on a surgical ward.
Intervention: Introduce a simple daily VTE checklist integrated into the ward round proforma.
Result: Compliance improved to 88% after two PDSA cycles.
Portfolio value: High — measurable outcome, clear change, demonstrable impact.
Project 2: Sepsis Recognition Education
Problem: Audit showed 40% of septic patients did not have all Sepsis Six elements documented within 1 hour.
Intervention: 15-minute bedside teaching sessions for nursing staff + laminated Sepsis Six poster in clinical areas.
Result: Sepsis Six completion rate improved from 58% to 79% at re-audit 6 weeks later.
Project 3: Discharge Summary Quality Improvement
Problem: Discharge summaries missing medication reconciliation in 50% of cases.
Intervention: Mandatory medication field in electronic discharge system + education session for house officers.
Result: Completion rate improved to 92%.
QI Frameworks to Know
- PDSA: Most widely used — applicable everywhere
- Model for Improvement (IHI): Combines PDSA with three fundamental questions
- LEAN: Waste reduction — particularly useful in theatre and outpatient settings
- Six Sigma: Data-driven variation reduction — less common at resident level
- Driver Diagram: Visual tool mapping primary and secondary drivers toward your aim
Documenting Your QIP
- Use run charts or SPC charts (simple line graphs over time) to show change
- Document each PDSA cycle separately — even small iterations count
- Present at a departmental meeting or grand round to add dissemination evidence
- Submit a brief report or poster — some departments will display your work
- Aim for written confirmation from your supervisor or department head