Table 3

Summary of PDSA cycles to improve blood test quality

PDSA descriptionBlood test quality (average per cent conducted correctly in PDSA period)
Sending the appointment letter with <2 weeks’ notice to arrange blood tests
(July–August 2016)
PDSA 2: increasing the notice to 4 weeks
(September–October 2016)
Amendments to the appointment letter to make it clearer what the patient needed to request and the levels to be taken. Patient feedback also suggested that patients found the number of blood pressure readings requested were excessive. Based on this, the requirement for BP readings was reduced.
(November–December 2016)
Declines in blood test availability below the control limit prompted further changes to the appointment letter. These changes included: noting that it was essential for the form to be used and kept safe by the patient and improved checkbox layout. This coincided with the clinic roll-out to other consultants and the booking process been managed by the central booking team. The transplant nurse specialist also ceased to individually call patients to ensure that the correct blood tests were done. Patient feedback and liaison with local laboratories clarified that this was due to blood test forms being filled out incorrectly. (January–February 2017)
Amendments in PDSA 4 did not yield sufficient improvements to blood test quality. Therefore, the appointment letter changed to take a different approach—with very clear ‘step-by-step’ instructions for both patients and primary care staff.
The initial impact of this change was unclear. Blood test quality went above and below control limit for the first six tele-clinics. The final four tele-clinics all saw quality levels above the control limit.
(March–July 2017)
  • PDSA, Plan–Do–Study–Act.