Ensuring availability of in date and fit for purpose emergency guidelines in all anaesthetic areas throughout the South East Scotland deanery

Abstract

Our aim was to institute a system whereby emergency anaesthetic guidelines are available in >90% of appropriate clinical areas throughout each of the acute hospital sites in three health board administrative regions, and whereby >90% of available guidelines are deemed to be in date and fit for purpose. Our objective was to achieve these targets within 6 months. Using quality improvement methodology, we inventoried available emergency anaesthetic guidelines in 132 locations throughout seven acute care hospitals. Five guidelines were then randomly selected per site per month and assessed for three process markers: was the guideline available in all appropriate areas, was it in-date (i.e. within date of review as specified on guideline or on consultation with author) and was it fit for purpose. Fitness for purpose was assessed by asking a junior colleague to simulate the emergency in a table top exercise using the guideline to aid management. This project was also used as a surveillance system to highlight outdated, unfit or missing guidance. Interventions included iterative revision of the master guideline lists, removal of outdated or unfit guidelines and creation or updating of guideline folders. 30 guidelines were assessed pre-intervention and 203 post-intervention. 52% of guidelines were available in appropriate areas pre-intervention rising to 76% post intervention, 67% of guidelines were in date pre-intervention rising to 82% post-intervention and 87% of guidelines were deemed fit for purpose pre-intervention rising to 92% post-intervention. We have demonstrated that regular review of emergency guidelines to maintain their currency is achievable and also demonstrated the feasibility of recruiting over 20 trainees across a training deanery to complete a QI project. We believe that organisations should maximise the resource of highly motivated trainees to achieve their QI goals.