BEVA Congress isn’t the only equine event just around the corner; an RCVS Knowledge roadshow, approved by BEVA, will provide insight, examples and advice on implementing quality improvement (QI) in the specialism. Beginning next month, the roadshow, sponsored by the Horserace Betting Levy Board (HBLB), will take place on two dates in 2019: 22 October at Rossdales Equine Hospital and 5 December at Ashbrook Equine Hospital.
The roadshow will draw on real-life examples and available support – specific to equine practice – to enable practitioners to get the most from methods such as clinical audits, benchmarking, checklists, significant event audits and guidelines. These are all practical techniques to ensure care provision is continuously improving. Care should be based on the best available evidence, combining clinical expertise, the most relevant and best available scientific evidence, patient circumstances and owners’ values.
Several sessions, outlined below, will delve into areas and scenarios within practice in which quality improvement techniques can be applied, as well as the impact they have already had in equine clinics.
A pathway to improvement
Quality improvement can provide a framework and structure for turning mistakes into learnings and opportunities to improve care. The session will take cues from Rossdales Equine Hospital, which has emphasised the implementation of a clinical governance policy, and practical advice on making improvement while maintaining a no-blame culture will be provided.
Going from very little focus on continuous improvement to implementing widespread QI in practice can be daunting but, as demonstrated by VetPartners’ clinical excellence strategy, there is a pathway to making it a reality. The group’s achievements across local and national settings prove that such a change is possible, whether at an individual equine practice, a large hospital or a corporation.
Reducing errors and increasing patient safety
Demonstrated by a real clinical incident – an anaesthetic complication – in an equine practice, the multifaceted nature of what may sometimes appear to be obvious mistakes will be explored in this session.
A lot can be learnt from a significant event, with proper auditing not only vastly decreasing the chances of the incident happening again, but also positively impacting other areas.
Another method of reducing the chances of significant events occurring is through checklists. Originally stemming from the aviation industry, checklists have been adopted by a number of other professions, including human healthcare. A cornerstone of QI, checklists are simple but very effective ways of reducing human errors and improving patient safety.
Forming guidelines and benchmarking
A major limitation to developing evidence-based guidelines in equine practice is the frequent absence of available evidence. However, this does not prevent practice guidelines from being developed. Evidence can be collated from less obvious sources and supplemented by expert opinion and clinical experience. With a particular focus on colics, castrations and antimicrobials, seven steps to creating a guideline will be presented in this session.
Benchmarking allows individual practices to compare their statistics against set standards, but collecting data in a busy equine practice can be challenging. A new app and website that obtains data to ascertain rates of morbidities and mortality in horses undergoing surgery for colic offers clinics a technological solution and the capability to analyse their performance against national and international averages.