RCEM SLO 11: A Practical Guide to Quality & Safety in the ED

Target Audience: NHS Emergency Medicine Doctors (ACCS, HST, CESR) and Advanced Practitioners.

Subject: Shared Learning Outcome (SLO) 11: Participate in and promote activity to improve the quality and safety of patient care.

Executive Summary

Specialty Learning Outcome (SLO) 11 represents a fundamental shift in the Royal College of Emergency Medicine (RCEM) curriculum, moving away from a single examination hurdle to a continuous, longitudinal assessment of Quality Improvement (QI) and patient safety.

Critical Takeaways:

Continuous Assessment: QI is no longer an isolated event; it is "spiralled" through training, requiring evidence of engagement at every stage (Core, Intermediate, and Higher).
Methodology Focus: The emphasis has shifted from simple audit to mastering QI methodologies (e.g., PDSA, Driver Diagrams) and understanding the "journey" of improvement.
The Tool: The Quality Improvement Assessment Tool (QIAT) on Kaizen is the primary mechanism for recording and assessing this activity.
Scope: Projects are no longer limited to clinical topics; they can cover education, environmental sustainability, wellbeing, or cost-saving.

1. Strategic Context: The Shift to Longitudinal Learning

The 2021 Curriculum integrates QI throughout training to align with GMC requirements, ensuring that quality and safety are not treated as a "tick-box" exercise but are embedded in daily practice.

Spiralling: The curriculum utilizes an educational approach of "interleaving" and "spacing" content. This prevents the reluctance often seen in trainees to engage in QI work after passing a single exam.
Breadth of Experience: Trainees are expected to record and reflect upon a breadth of experience across different settings, identifying their own strengths and weaknesses.

2. Competency Progression by Training Stage

Expectations for SLO 11 evolve as the trainee progresses. It is critical to select projects commensurate with your current level.

ACCS / Core Training (CT1-ST2)

Focus: Participation and understanding.
Requirements:

Demonstrate a basic understanding of key QI principles.
Reflect on the team-based nature of QI work.
Engage with audit/QI work each year.

Evidence: QIAT, Multiple Consultant Report (MCR), Multi-Source Feedback (MSF) .

Intermediate Training (ST3)

Focus: Data analysis and evaluation.
Requirements:

Record a project with additional data analysis.
Evaluate the changes made.
Feedback on trainee contribution to a QI project.

Evidence: QIPAT, MCR, MSF .

Higher Specialist Training (HST / ST4-ST6)

Focus: Leadership and completion.
Requirements:

Lead a project from start to finish.
One larger project is required during HST.
Review by a regional panel including QI expertise (specifically for ST6 under the 2015 curriculum, or generally for HST assurance).

Evidence: Educational Supervisor’s Structured Training Report (STR), QIPAT, MCR .

3. The Assessment Tool: QIAT

The QIAT (Quality Improvement Assessment Tool) is the standardized reporting form on Kaizen. A good QIAT typically covers the equivalent of 7–8 pages of A4. It is divided into three distinct sections:

Part 1: The Project

Problem Analysis: Why is this a problem in your department? .
Methodology: Justification of the chosen method (e.g., Model for Improvement, Lean, Six Sigma).
SMART Aim: Specific, Measurable, Achievable, Relevant, Time-bound objectives.
Outcomes: Measurement of outcome, process, and balancing measures, utilizing run charts or SPC charts.
Interventions: Description of PDSA (Plan, Do, Study, Act) cycles and what was learned from them.

Part 2: Working with Others

Team Dynamics: How the team was chosen, how contributions were encouraged, and how conflict was managed.
Stakeholders: Analysis of stakeholders, prioritization, and management of external engagement.
Patient Involvement: How the patient/carer voice was engaged to improve quality of care .

Part 3: Reflection on Leadership

Self-Awareness: Reflection on personality, strengths/weaknesses, and working under pressure.
Learning: What was learned about QI and leadership from the experience.
Personal Development: Plans for future QI career stages.

4. Practical Toolkit and Methodologies

To satisfy the evidence requirements, you must utilize recognized QI tools. The sources recommend including the following artifacts in your document library, linked to your QIAT:

Driver Diagrams: To visualize the strategy and drivers of change.
Fishbone (Ishikawa) Diagrams: For root cause analysis.
Process Mapping: To understand the current system flow.
Run Charts/SPC: To display data over time (minimum of 2 data points required, ideally more for validity).
Stakeholder Analysis: To identify key players and engagement strategies.

Note regarding "Educational QIPs": You may conduct projects on education, wellbeing, or sustainability. There is no longer a narrow set of acceptance criteria.

5. Human Factors and Safety Descriptors

SLO 11 extends beyond the QI project itself. It requires the demonstration of specific professional behaviors and safety competencies in daily practice.

Key Descriptors:

Prioritization: Makes patient safety a priority in clinical practice.
Escalation: Raises and escalates concerns regarding patient safety or quality of care issues.
Investigation: Demonstrates commitment to learning from patient safety investigations and complaints.
Human Factors: Understands principles at individual, team, and organizational levels.
Non-Technical Skills: Understands the importance of crisis resource management.
Competence Limits: Recognizes limits of personal competence and avoids unnecessary investigations.

6. Learning Aids and Mnemonics

SMART Aim

Ensure your project aim is defined using this framework:

Specific
Measurable
Achievable
Relevant
Time-bound

Example from source: "80% of Asthmatic patients being discharged from the emergency department should meet the RCEM standards by the end of July 2019".

The PDSA Cycle

The iterative engine of improvement:

Plan: Objective and predictions.
Do: Carry out the plan.
Study: Analyze the data.
Act: Adapt, adopt, or abandon.

References

Royal College of Emergency Medicine. SLO 11 Participate in and promote activity to improve the quality and safety of patient care. [Source 1, Page 1]
Royal College of Emergency Medicine. What is SLO 11? [Source 1, Page 1]
Royal College of Emergency Medicine. 2021 Curriculum. [Source 1, Page 1]
Royal College of Emergency Medicine. The QI Assessment: A How-To Guide. [Source 2, Page 2]
Royal College of Emergency Medicine. Develop Your Plan of Attack. [Source 1, Page 1]
Royal College of Emergency Medicine. Overview of the Approach to Participate in and Promote Activity. [Source 1, Page 2]
Royal College of Emergency Medicine. SLO 11 Independent Ongoing Learning. [Source 1, Page 2]
Royal College of Emergency Medicine. What is the QIAT? [Source 2, Page 2]
Royal College of Emergency Medicine. Can I do an educational QIP? [Source 2, Page 2]
Royal College of Emergency Medicine. Is the QI assessment the same for everyone? [Source 2, Page 3]
Royal College of Emergency Medicine. What do I put in the QIAT? [Source 2, Page 4]
Royal College of Emergency Medicine. Suggestions for evidence. [Source 2, Page 6]
Royal College of Emergency Medicine. Appendix: an annotated exemplar QIAT. [Source 2, Page 9]