How can I demonstrate quality improvement in my practice including my use of complex, new or unusual procedures?

This case study will help if you:

  • use surgical or other interventional procedures
  • practise both in the NHS and independent healthcare sector
  • perform new, complex or unusual procedures

The National Institute for Health and Care Excellence (NICE) worked with us to develop this case study. NICE’s interventional procedures guidance applies across the UK. However, other NICE guidance products may not always apply across the four countries of the UK, and we therefore recommend speaking to your employer if you have any questions.

Key points to consider

  • The supporting information you bring to your appraisal should cover the whole of your practice, including any NHS and independent sector work you do.
  • Your appraiser, employer or professional membership body can offer advice on what information to bring and how to present it.
  • Your employer should provide you with the opportunity to participate in national and local audits if one is being conducted in your area of practice. Your employer should also give you appropriate data to allow you to reflect on the outcomes of audits.
  • Any new techniques and procedures you use should be overseen by appropriate governance structures, which may include seeking authorisation from your hospital’s novel interventional procedures committee.
  • National guidelines and quality standards relevant to areas of your practice can be used to guide the information you provide for your appraisal as well as reflection and discussion.

Scenario – Dr Baban

Dr Baban is an interventional cardiologist working across the NHS and independent sector. He performs planned and emergency coronary interventions as well as transcatheter valve interventions. He is considering how to demonstrate quality improvement across his whole practice.

How the doctor met our requirements

Dr Baban spoke to his appraiser who advised him to look at the guidance on appraisal produced by the relevant professional societies and the Royal College of Physicians. She also advised him to read the NICE’s interventional procedures guidance for the transcatheter interventions he performs.

As part of his role, Dr Baban contributes data to national audits relating to percutaneous coronary interventions and transcatheter interventions. He also participates in joint cardiovascular morbidity and mortality meetings at all settings in which he works.

The cardiovascular directorate of his NHS hospital has an agreed governance structure for the management and delivery of transcatheter interventions. This is inline with NICE guidance and involves multidisciplinary team discussions on how patients are selected for this treatment, data collection and outcomes audits, submissions to the appropriate national audit, and regular multidisciplinary morbidity and mortality meetings.

Before undertaking a transcatheter intervention in his private practice, Dr Baban and colleagues presented to the independent hospital’s medical advisory committee and agreed how decisions would be made across the multidisciplinary team and how outcomes data would be collected and audited.

At his appraisal, he presented outcomes data for all the procedures he has performed in both his NHS and independent sector practice. This included indications and outcomes data for his planned and emergency coronary interventions using information from databases held by the National Institute for Cardiovascular Outcomes Research, as well as longer-term outcome data based on clinic follow ups. Both his department in his NHS Trust and his private hospital support him in extracting data from their systems. He demonstrates that he performs a sufficient number of coronary interventions to maintain proficiency and undertakes procedure for appropriate indications and with acceptable outcomes

Given the relatively small number of transcatheter interventions undertaken, it’s difficult to benchmark his outcomes against national standards. However, he:

  • presented evidence of reflection on cases discussed at morbidity and mortality meetings and an in-depth review of a case involving a serious complication and adverse patient outcome along with reflection and lessons learned.
  • presented evidence of discussion and peer review of practice with another centre performing the same transcatheter intervention and his learnings reflected on his outcomes and practice and on the risks associated with undertaking complex interventional procedures and how these can be managed in practice.