What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

This scale up and spread project will embed in to practice successes achieved in a pilot project to reduce the variance and increase outcomes of patients having vascular assessments in the Salford Care Organisation (SCO) of the Northern Care Alliance (NCA).  The initial aim was to achieve 85% of patients attending community services in Salford to have a best practice vascular assessment by June 2024.  This collaborative project with Keele University has used QI methodology to understand the barriers and facilitators to best practice assessments, developing key primary and secondary drivers and establishing change ideas for implementation.  We now aim to scale and embed this learning across multiple systems and teams (podiatry, tissue viability, district nursing) within SCO and to spread this work further, engaging teams from the other care organisations within the NCA.

What does your project aim to achieve?

Diagnosis of peripheral arterial disease is often determined by hands-on assessments undertaken by skilled community teams including podiatry, district nursing  and tissue viability services.  Patient’s journey to a vascular surgical opinion differ depending on which team they are initially referred to and the assessment that is completed. We aim to embed a newly developed process where all patients receive the same standardised, best practice vascular assessment, meaning the right referral and intervention/s can be made at the right time, increasing system efficiencies and avoiding deterioration in a vulnerable patient population.

We will take the learning from the initial project within Salford Care Org and embed this learning further within the teams already engaged as primary stakeholders as well as deliver across the Northern Care Alliance.

We will further explore and leverage our primary drivers including staff education, appropriate equipment, evidence-based community pathway and most importantly a safe and supported culture.

How will the project be delivered?

The current project has a ‘sustainability factor’ developed with the academic team from Keele University, who have worked closely with the project leads from podiatry since the initial pilot. This will inform the measurement of the impact and ’embededness’ of the intervention.

The Podiatry team leading this project have worked closely with QI leads to use QI foundations and the Knowledge To Action framework that form the methodological basis for delivery. The team will continue to be supported with QI support and expertise through the NHS GM Salford Locality and NCA QI departments, lending a local system approach to this scale up and spread QI initiative.

Operational delivery of this improvement project will be via 0.7WTE of an Advanced Vascular Podiatrist, supported via the skills, knowledge and passion for improving patient care of the wider podiatry team and their drive to embed an improvement initiative they had led from inception.

How is your project going to share learning?

This project will hopefully demonstrate that applying QI methodology to a patient group that sits across multiple professions as well as geographical areas can bring about sustainable changes and outcomes to patients.

Project leads are linked in to the Manchester Amputation Reduction Strategy (MARS), and would also seek to share their learning through relevant professional bodies and events.