Recommended QI Project: Improving Bowel Preparation Quality for Colonoscopy

Why This Project

Project Framework (SMART)

What You Would Actually Do

• Review endoscopy reports for BBPS scores over the past 1–3 months
• Identify which patient subgroups had inadequate prep (elderly, diabetic, opioid users, those with poor literacy)
• Note whether split-dose vs. day-before prep was used

• Design a one-page visual/plain-language bowel prep instruction sheet
• Add a structured pre-procedure phone call checklist confirming patients understand key steps (dietary restrictions, timing, hydration)
• Alternatively, help implement a "prep failure risk stratification" system that flags high-risk patients for extra counseling

• Compare BBPS scores pre- and post-intervention
• Calculate change in adequate prep rate
• Present findings at a departmental meeting or GI grand rounds

Deliverables You Can Own as a Medical Student

• Patient education material — revised prep instructions (plain language, diagrams)
• Data audit spreadsheet — before/after BBPS scores
• QI poster or short report — ideal for a conference abstract or portfolio
• Process flowchart — showing the intervention pathway

Alternative Project Ideas (Also Student-Feasible)

Tips for Getting Started

1. Talk to a GI fellow or faculty mentor first — frame it as wanting to help with an ongoing or needed project; many departments have data already being collected.
2. Use PDSA cycles (Plan-Do-Study-Act) — this is the standard QI methodology and what reviewers expect on a poster or abstract.
3. Check if your institution uses Epic — many BBPS scores, prep orders, and surveillance intervals can be pulled via a simple EMR report without manual chart review.
4. The ASGE quality indicators document lists published benchmarks (adenoma detection rate, withdrawal time, cecal intubation rate) that serve as ready-made QI targets.

Bottom Line

Recommended QI Project: Reducing Neonatal Hypothermia on NICU Admission

Why This Project

Project Framework (SMART)

What You Would Actually Do

• Review admission temperature records for preterm infants over the past 1–3 months
• Calculate the current hypothermia rate on admission
• Identify where temperature loss occurs: delivery room, transport to NICU, or at admission
• Survey nursing staff on current practice (polyethylene bag use, pre-warmed resuscitation table, delivery room temperature)

• Delivery room temperature ≥ 26°C before delivery
• Immediate wrapping in polyethylene bag/occlusive wrap (< 28 weeks) without drying
• Pre-warmed transport incubator (set to 37°C)
• Exothermic mattress/chemical warming pad for transport
• Pre-warmed NICU incubator before arrival
• Temperature documented within 30 minutes of admission

• Compare pre- vs post-bundle hypothermia rates
• Identify which bundle components were consistently followed and which were missed
• Present at departmental grand rounds or morbidity & mortality conference

Deliverables You Can Own as a Medical Student

• Warm Chain checklist — a laminated single-page card for the delivery team
• Audit data spreadsheet — admission temperatures and bundle compliance rates
• Run chart — plotting weekly hypothermia rate over time (standard QI display)
• QI poster or abstract — submittable to national meetings (PAS, AAP, NNN)

Why This Is Right for a Medical Student

• Requires no prescribing — it's a process and education intervention
• You can collect data from existing admission temperature logs without needing ethics approval in most institutions
• The checklist you create has immediate tangible impact at the bedside
• It's aligned with Vermont Oxford Network (VON) and CPQCC quality benchmarks, so your institution may already be tracking it
• Multiple published examples exist to guide your methodology — you're not starting from scratch

Alternative Project Ideas for Neonatology

Tips for Getting Started

1. Frame it as supporting ongoing work — most NICUs belong to VON or CPQCC collaboratives that already collect this data. Ask the attending or fellow what benchmarks the unit is currently below target on.
2. Use PDSA cycles — one small test of change at a time (e.g., introduce the checklist on one shift first, measure, refine, then expand).
3. The "Warm Chain" bundle is endorsed by WHO, AAP, and ILCOR — you have strong guideline backing to support the intervention.
4. Temperature data is routinely collected at NICU admission — you likely only need retrospective chart review, which is usually exempt from full IRB review.

Bottom Line

• Keep it short — neonatologists are busy; this gets to the point quickly without overwhelming them with project details upfront.
• Don't attach a proposal yet — save the full project outline for the meeting itself. The goal of this message is only to get the meeting.
• If sending by email, the subject line above works well. If approaching in person on the ward, use the same talking points but drop the formal opening.
• Personalise it — if you know the consultant has a specific interest (e.g., they run the unit's VON reporting or have published on neonatal thermoregulation), add one line acknowledging that. It signals you've done your homework.

Recommended QI Project: Improving Timely Referral to the Colorectal Cancer MDT (Multidisciplinary Team)

Why This Project

Project Framework (SMART)

What You Would Actually Do

• Review records of all newly diagnosed colorectal cancer patients over the past 3–6 months
• For each case, record:
  • Date of confirmatory biopsy report
  • Date of first MDT discussion
  • Whether an MDT treatment plan was documented in the clinical notes
  • Whether the plan included staging CT, MRI rectum (if applicable), CEA, and KRAS/MMR/MSI testing
• Calculate: % discussed at MDT within 14 days, % with complete MDT documentation

• A one-page referral proforma attached to every positive CRC biopsy report (electronic or paper)
• Checklist ensures: staging imaging ordered, tumour markers sent, genetic/MSI testing flagged, and MDT date booked — all before the MDT meeting
• Educate referring teams (surgical residents, gastroenterology fellows) on the checklist via a brief teaching session or email

• Re-measure MDT referral timeliness and documentation completeness
• Identify remaining gaps (e.g., delays from pathology, radiology bottlenecks, incomplete referrals)
• Present findings at the oncology departmental meeting or tumour board

Deliverables You Can Own

• MDT referral proforma / checklist — immediately usable at the bedside
• Audit data spreadsheet — time-to-MDT and documentation rates, before and after
• Run chart — weekly MDT referral compliance over time
• QI poster — submittable to ASCO, ESMO, or national oncology meetings

Alternative QI Project Ideas in Colorectal Cancer Oncology

Why the MDT Referral Project Is the Best Starting Point

1. Data is accessible — MDT dates and biopsy report dates are in every hospital system; you only need retrospective chart review.
2. No prescribing or clinical authority required — you are auditing a process and designing a documentation tool.
3. Immediate patient impact — a delay to MDT is a delay to treatment. Even a small improvement has direct clinical consequences.
4. Strongly guideline-backed — NICE CG151, ESMO CRC guidelines, and NHS Cancer Waiting Times standards all mandate 2-week wait pathways and MDT review, giving you clear benchmarks.
5. Publishable — process audit + intervention studies in oncology QI regularly appear in journals like Clinical Oncology, BMJ Open, and ESMO Open.

Getting Started

• Ask your oncology consultant or colorectal cancer nurse specialist (CNS) for the MDT meeting attendance list — this is your primary data source.
• Frame the project around the 62-day cancer waiting time target (NHS) or equivalent national standard in your country — this gives institutional motivation to engage.
• Use PDSA cycles: start with one small change (e.g., the referral checklist on the surgical ward) before scaling unit-wide.

Recommended QI Project: Improving Completeness of Biomarker Testing (ER, PR, HER2, Ki-67) at Diagnosis

Why This Project

Project Framework (SMART)

What You Would Actually Do

• Review records of all newly diagnosed invasive breast cancer patients in the past 3–6 months
• For each case, check whether the following were documented at or before first MDT discussion:
  • ER and PR status (Allred score or H-score)
  • HER2 status (IHC ± ISH if equivocal)
  • Ki-67 proliferation index
  • Tumour grade and stage (T, N, M)
  • BRCA1/2 referral (if criteria met — age <50, triple negative, family history)
• Calculate: % with complete biomarker panel, % with any missing result, average time from biopsy to complete biomarker report

• A single proforma that flags all required biomarkers and automatically prompts the referring team if any are missing
• A standard message/alert sent to pathology if HER2 ISH reflex testing has not been requested for equivocal IHC 2+ cases
• A brief education session for surgical/oncology trainees on why each biomarker is required and what triggers BRCA referral

• Re-measure completeness of biomarker documentation at MDT
• Measure time from biopsy to complete panel (before vs. after)
• Present at the breast oncology MDT or departmental audit meeting

Deliverables You Can Own

• Diagnostic checklist proforma — immediately usable in clinical practice
• Audit spreadsheet — biomarker completeness rates before and after
• Run chart — weekly completeness rate over time
• QI poster or short report — submittable to ESMO Breast, ASCO, or SABCS (San Antonio Breast Cancer Symposium)

Alternative QI Project Ideas in Breast Cancer Oncology

Why the Biomarker Completeness Project Is the Strongest Choice

1. Data already exists — pathology reports and MDT records are archived; you need only retrospective chart review.
2. No prescribing required — the intervention is a checklist and referral process tool.
3. Direct treatment impact — a missing HER2 result can delay trastuzumab by weeks; a missing BRCA referral can miss a prophylactic intervention for a family.
4. Nationally benchmarked — the UK National Audit of Primary Breast Cancer (NAoPri, 2024) lists reducing variation in biomarker documentation as a top 5 quality goal, giving you authoritative backing.
5. Scalable and publishable — similar audits have been published in Breast, Clinical Oncology, and ESMO Open.

Getting Started

• Ask the breast cancer nurse specialist (CNS) or MDT coordinator for the list of cases discussed at MDT over the past 3 months — this is your dataset.
• Cross-reference with the pathology system to check which biomarkers were reported and when.
• Use a simple traffic light system on your spreadsheet (green = complete, amber = delayed, red = missing) to visualise gaps quickly.
• Align your project with the NAoPri indicators (National Audit of Primary Breast Cancer) — your institution may already be submitting data to this audit, making your project directly relevant to national reporting.