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Scaling Up Quality Improvement for Surgical Teams (QIST): avoiding surgical site infection and anaemia at the time of surgery: a randomised controlled trial

York Trials Unit (YTU) is working with Northumbria Healthcare NHS Trust to assess the effectiveness and cost effectiveness of the Institute for Health Improvement (IHI) Breakthrough Series Collaborative model for introducing service improvements at scale in the NHS, specifically for improving outcomes in patients undergoing elective total hip and knee replacements.

What is a Breakthrough Series Collaborative?

An IHI Breakthrough Series Collaborative is a short-term (6- to 15-month) learning system that brings together a large number of teams from hospitals or clinics to seek improvement in a focused topic area. Each team typically sends three of its members to attend Learning Sessions, with additional members working on improvements in the local organisation. The Learning sessions are facilitated by experts in the topic area of interest and individuals trained in the methodology.

Why is this study needed?

Implementing service improvements that have been show to work remains a challenge for the NHS. Screening pre-operatively for MSSA and providing patients with a decolonisation pack where necessary and identifying and treating anaemia pre-operatively are two such service improvements. Both have been shown to improve patient outcomes and to save costs but neither is included in routine practice across the NHS. There is a need to identify effective mechanisms for introducing change at scale in healthcare.

What type of study is this?

QIST is a cluster randomised controlled trial. Twenty NHS Trusts taking part in the study will be randomised to receive training and support in how to introduce the MSSA quality improvement initiative in their own Trust. A further 20 Trusts will be allocated to training for the anaemia quality improvement initiative. The groups of Trusts will act as controls for each other and at the end of the trial will be given the option of training in the alternative initiative. The trial will use quantitative and qualitative methods to examine the process of implementing the protocols in each Trust and assess the cost effectiveness.

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  • NHS Improvement Northumbria
  • Acute Care Collaboration Vanguard
  • Vifor Pharma
  • Schuelke
Start date: 1st September 2017
End date: 31st July 2020


YTU Team:

External Team:

  • Professor Mike Reed (Chief Investigator), Consultant Trauma and Orthopaedic Surgeon, Northumbria Healthcare NHS Foundation Trust
  • Ashley Scrimshire, Trauma and Orthopaedic Surgery Specialty Registrar, Northumbria Healthcare NHS Foundation Trust
  • Gillian Davis, Project Support Manager, Northumbria Healthcare NHS Foundation Trust
  • Annie Laverty, Director of Patient Experience, Northumbria Healthcare NHS Foundation Trust 
  • Dr Win Tadd, Independent qualitative researcher

 QIST - logo

Medium size YTU logo (fits in right hand column)

QIST - Northumbria NHS