Quality Improvement, Clinical Audit, Perioperative Safety Metrics, and Research Ethics — WACS Viva & Clinical Scenarios (Statistics & Evidence-Based Practice)

Exam-style quality improvement, clinical audit, perioperative safety metrics, and research ethics viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: You are appointed the perioperative quality improvement lead in a regional hospital where postoperative hypothermia (core temperature < 36.0°C) is occurring in 65% of adult patients undergoing major general surgical procedures lasting over two hours. Detail how you will design, implement, and evaluate a multi-stage Plan-Do-Study-Act (PDSA) quality improvement initiative to reduce hypothermia rates using accessible, low-cost warming modalities.
• SCENARIO 2: A 28-year-old primigravida undergoes an emergency caesarean section for fetal distress at midnight. Post-induction, an ampoule of pancuronium is mistakenly drawn up and administered instead of ephedrine to treat post-spinal hypotension, leading to total motor paralysis while the patient is fully awake. Following immediate airway control and recovery, you are tasked with leading the Root Cause Analysis (RCA). How do you structure the RCA using an Ishikawa (fishbone) diagram and human factors analysis to address organizational and latent system failures?
• SCENARIO 3: You observe that compliance with the 'Sign-Out' component of the WHO Surgical Safety Checklist in your main operating theatre suite has dropped to 15%. Explain the five distinct stages of the Clinical Audit Cycle, establishing explicit audit criteria, setting standards, identifying barriers to compliance, implementing targeted corrective actions, and executing the mandatory re-audit step.
• SCENARIO 4: You are preparing an ethical submission for a prospective randomised clinical study evaluating two different ketamine-propofol (ketofol) ratios for emergency procedural sedation in paediatric burn dressing changes. Formulate your research protocol to address the four fundamental principles of biomedical ethics (Autonomy, Beneficence, Non-Maleficence, Justice), child assent, parental proxy consent, and institutional review board (IRB) requirements.