1. The document describes a survey of anaesthetic trainees in Merseyside that found they collectively spent over 1000 hours on audits but only 16% resulted in recognizable practice changes. 2. It then outlines the formation of MAGIQ (Mersey Anaesthetic Group for Improving Quality) to help trainees collaborate on quality improvement projects and overcome barriers like lack of time, resources and support. 3. One such project was a Mersey-wide initiative to increase the use of pre-intubation checklists, which through rapid audit and feedback across 11 hospitals was able to increase checklist use from 51% to 87% over 8 weeks.

1. Matthew Bridge
Nick Lown

2. Introduction
1 Who are we?
2 Merseyside Anaesthetic Trainees Audit
Activity Survey
3 Forming MAGIQ
4 Mersey Intubation Checklist Project

3. Who are we?

4. Who are we?

5. Lesson 1
Just get
started

6. Mersey Anaesthetic Trainees’ Audit Activity Survey
Experiences Best practice Impact
Audit Activity
Survey
•Barriers
Time
Criticism
•Resources
Access to
influence
•Project
selection
•Audit
standard
•Collaboration
•Feedback
•Intervention
•Impact if
reaudited
•Time invested

7. Develop survey items
Draft surveys
Pilot testing
Medline search 21 sources identified
13 key sources Cochrane review,
HQIP, NICE, RCOA
guidance, peer
reviewed articles
SurveydevelopmentAudit Activity
Survey

8. •Recruited survey representatives
•11 sites across the Mersey
Deanery
•100 questionnaires distributed
•Total responses = 69
•Total number of audits >215
Audit Activity
Survey

9. Number of trainees, n=69
Estimated hours worked per
audit
11
17
18
21
0 10 20
0-5hrs
6-10hrs
11-15hrs
16-20hrs
21+ hrs
Projects
reaudited
AND
recognisable
change in
practice
16%
Estimated >1000+ hours total !
Audit Activity
Survey

10. Lesson 2
People
aren’t used
to change

11. Forming
MAGIQ
•“This has failed before why should it
work this time?”
•“Going for consultant jobs are we?”
•“Pyramid scheme!”
•“What’s in it for me?”
•“Even if you do your project and your
data shows an improvement in practice
you won’t have changed practice really”

12. 1989 white paper
established requirement
for clinicians to participate
in audit
2010 RCoA curriculum –
“Can lead teams to
introduce a clincal quality
improvement”
Forming
MAGIQ

13. Lesson 3
Seek out
help and
support

14. •Individuals with an interest in QI
•Audit departments
•National groups
Forming
MAGIQ

15. Group manual
Mersey Anaesthetic Group for Improving Quality
Website
www.merseymagiq.com
Forming
MAGIQ

16. Forming
MAGIQ

17. Lesson 4
Persevere, show
people that you’re
making an effort,
be meticulous and
dedicated

18. Mersey Anaesthetic Group for Improving Quality
Forming
MAGIQ

19. Intubation
Checklist

20. Intubation
Checklist

21. Aims
• Achieve >90% use of pre-intubation checklists
for emergency out of theatre intubations
within the 8 week period of the project.
• Increase the acceptance of pre-intubation
checklists for emergency out of theatre
intubations
Intubation
Checklist

22. Change
Processes
1 Multiple, rapid audit and feedback cycles
2 Social norms
Can we change behaviour?
Influence not imposition

23. Local emphasis
1. Rapid site specific
audit and feedback
cycles
2. Promote local
ownership of the
checklists
3. Identify barriers to
checklist use and
promote individualised
solutions
1. Inter-site
benchmarking
2. Sharing of solutions
and best practice
Central emphasis
Change
Processes

24. Context
1. Alder Hey
2. Aintree Theatres
3. Aintree ICU
4. Walton Centre
5. Royal Liverpool
Theatres
6. Royal Liverpool
ICU
7. Chester
8. Whiston
9. Warrington
10. Arrowe Park
11. Liverpool Heart &
Chest
Hospital Sites
1. Trainee Anaesthetists / ICM doctors
2. Consultant / non-career grade
Anaesthetists / ICM doctors
3. ODPs
4. ITU nurses
Main staff Groups
1. Intensive Care Units
2. A&E departments
3. Hospital wards
4. Radiology departments
5. Anywhere!
Locations

25. Lesson 5
Information
Governance is
probably not as
bad as you think

26. Data
Collection
Accident and Emergency

27. Accident and Emergency
Data
Collection

28. Accident and Emergency
Data
Collection

29. Data
Collection

30. ?
Data
Collection

31. Data
Collection

32. Feedback

33. Lesson 6
The technology
is out there (and
affordable)

34. Results
Hospital
performance by
week
Overall Checklist Use
Week 1
51%
Week 2
87%
n=319

35. Results
Hospital
performance at
beginning vs
end project
8/11 hospitals demonstrated an
increase in intubation checklist use

36. Summary
•Rapid audit & feedback and social norms can
increase the use of checklists for emergency
intubations
•Region wide, trainee led Quality Improvement is
feasible and effective

37. Future
Directions

38. Questions?
www.merseymagiq.com
@mersey_magiq