Training Case Studies - Silver Quality Improvement Training

Quality Improvement Training (silver) – Amy Hargreaves, Hepatology Clinical Nurse Specialist


“Attending the Silver training has given me more confidence to start and see through a project on my own.”

Amy Hargreaves is a Hepatology Clinical Nurse Specialist in an ambulatory care unit at Leeds Teaching Hospitals. Previously Amy worked in an acute surgical ward as a Senior Sister. Amy works with like-minded colleagues who all share the same ideas looking at improving services and outcomes for patients.

Immediately after attending the Silver QI training, Amy was involved in the development of a new pathway for laparoscopic cholecystectomy in acute surgery as well as looking at a new appendicetomy pathway. In addition, there are new projects that her team are starting within the hepatology department, including reviewing and improving the TACE procedure (transarterial chemoembolization, where chemo is injected directly into the tumour). In addition, Amy is currently working on improving documentation of National Early Warning Scores (NEWS) for deteriorating patients. This is a piece of work that she brought into her new job from her previous team.

Amy found the content of the Silver QI Training really useful in helping her break down the pathway on the above work into little sections, enabling her team to overcome various barriers. Amy found the PDSA cycles really valuable as this helped in testing different ideas and learning what works well and what doesn’t – and in particular giving her the confidence to know when to say that something isn’t working well, in the knowledge that anything that doesn’t work first time can be re-addressed. Attending the training has also helped Amy’s confidence as previously she would have asked for advice from her colleagues and peers before undertaking any project but now Amy feels that she can start and see through a project on her own.

Amy is continuing her work on TACE and improving the pathway with a view to incorporating patient pathways from other specialties, such as renal biopsies and colorectal iron infusions. The department has seen a huge reduction in bed days from an initiative where nurses insert paracentesis drains for patients with ascites, rather than patients being admitted to the ward. This work has resulted in 5 years in bed days being saved in 2 year period and Amy is keen to use her improvement skills to see if there are any other procedures that can be carried out in a day case capacity rather than requiring an admission.

Amy’s plan is now to train other staff in a variety of roles to use quality improvement approaches in future work on pathways and patient experience to improve overall services.

Amy attended the Improvement Academy Silver Quality Improvement training day, funded through the Yorkshire and Humber AHSN on 25th September 2018.