Improving access to respiratory outreach services in an acute teaching hospital– a quality improvement project

The Consultant-led multidisciplinary (physiotherapy & nursing) Respiratory Assessment Unit (RAU) of a large acute teaching hospital provides a range of services, including respiratory outreach to persons with chronic lung disease. In 2016, a quality improvement (QI) team was formed comprising 7 RAU team members and 2 QI coaches-in-training, in collaboration with Dartmouth College, USA. The aim was to assist staff deliver better patient care and improve patient and staff experiences of care through coaching in QI skills using the Clinical Microsystems QI approach (Nelson, E. et al. Jt Comm J Qual Patient Saf 2008; 34:367-78). The RAU team and coaches met for one hour weekly over 6 months. The QI process began with an examination of the “5P’s” (purpose, patients, professionals, processes and patterns) to understand the RAU service framework. The QI theme chosen was access and the project aimed to improve the number of patients referred to the respiratory outreach programme by 20% by December 2016. Change ideas to achieve this aim included increased presence of RAU staff in the Emergency Department (ED), contacting Registrar on call at start of each shift, daily education huddle with ED/medical unit staff, a campaign on social media and monthly service reports to key stakeholders. Small improvements were tested each week using Plan-Do-Study-Act (PDSA) cycles. There was a 25% increase in referrals to the respiratory outreach service over the 6 month period. Through QI coaching, the RAU team learned vital skills such as process mapping and service evaluation. Staff were provided with a framework to address quality improvement in the service on an ongoing basis.