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HandsFirst QI Collaborative

This quality improvement (QI) project will focus on improving the quality of care for hand trauma patients. The project aims to improve outcomes for these patients by reducing variation and reducing time to surgery for this patient group.

Proposed project goal

That 80% of hand injuries that present to any service on the day of injury and require surgical intervention should have their first operation within the timeframe given in the BSSH hand trauma standards. 

These are specifically:

  • Within 24 hours for open joints and open fractures;
  • Within four days for all other open hand injuries;
  • Within seven days for closed hand fractures.

Limb-threatening injuries requiring more urgent intervention are excluded. For example:

  • Where revascularisation is required;
  • Compartment syndrome;
  • Where there is infection or risk of infection from e.g. bite wounds.

Project approach

The project will use a healthcare collaborative approach, defined as a short-term learning approach that brings together a number of teams from hospitals to seek improvement in a focused topic area.1

Combined with QI methodology, the use of a QI collaborative aims to close the gap between potential and actual performance by testing and implementing changes quickly across many groups.2 Project teams from each hospital will look at the best examples of care. Sharing of learnings within the collaborative allows each group to benefit from the successes and failures of others addressing similar issues, reducing duplication of effort and allowing solutions to be reached more rapidly.

QI involves implementing multiple, rapid cycles of change, in response to a specific, predetermined problem, and adapting the approach based on the results seen from each change. This is known as a PDSA (Plan, Do, Study, Act) cycle and has the benefit of allowing solutions to be tailored to the local environment, taking into account the context of the hospital they are being implemented in.

Support from clinical and QI experts was provided by RCS England through coaching sessions, online meetings, webinars, email support, and facilitation of group collaborative meetings.

What are the benefits?

Sites that join HandsFirst QI collaborative will receive:

  • Support from clinical and QI experts through coaching sessions, email support and teleconferences.
  • Access to a local data platform.
  • Peer collaboration with colleagues at participating sites.
  • Attendance at webinars and collaborative events.
  • Specially designed programme to meet each trust or health board’s specific needs.

The project team will work with participating sites to: 

  • Improve theatre utilisation by identifying which cases can be managed in alternative facilities.
  • Improve patient flow by utilising more efficient and agreed pathways, which will relieve pressure on emergency departments and assessment clinics.

If trusts/health boards implement these service changes, they will likely save money as there will be a reduction in the use of main theatre facilities (with more cases being managed in procedures rooms). There will also be fewer complications from delayed surgery. As a result of offering patients more timely surgery, we expect trusts/health boards will see a reduction in complaints received and reduce the risk of litigation.



Initiation: recruitment, payment and set-up 
April 2021 – September 2021

Launch and testing
October 2021 – December 2021 

Testing improvement ideas in practice
January 2022 – July 2022

Demonstrating sustained improvement
August 2022 – October 2022

Collaborative close 
November 2022

Evaluating and reporting
December 2022 – February 2023

HandsFirst project requirements

There is a one-off cost of £5,000 (including VAT) per trust or health board of to join the project. In addition, trusts and health boards need to cover their travel and expenses to any in-person meetings.

The named project lead should be allocated time in their job plan to lead the project locally.

Email Sheena MacSween to receive your registration form and secure your trust or health board's place on the project.

The closing date to join the project is 30 September 2021.

For more information on RCS England's QI collaboratives visit the following pages:

 1 See the Institute of Healthcare Improvement’s Breakthrough Series Collaborative work for more information.
 2 Improvement collaboratives in healthcare, Health Foundation, 2013:

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