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Table 2 Description of audit and feedback interventions

From: Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic review

Study and country

Format

Delivery

Data specificity

Audit data included in feedback

Instances of audit and feedback

Frequency/interval

Other intervention components

Feedback recipients

Solomon 1988

USA [50]

NR

Unclear (“reported”)

Group; unclear if individual

Transfusion ordering: “…it was determined that 43% of the transfusions were unjustified. The results of this audit were reported”

1

N/A

•Education

•Guidelines

•Administrative (new request form, policy)

Unclear (“leaders of the surgical and medical attending staff”)

Paes 1994

Canada [58]

Verbal, unclear if written component (NR)

“continuing medical education rounds” and unclear (“direct encounters”, “direct, immediate feedback”)

Individual; unclear if group

Lab test ordering: unclear; “information obtained from this audit,” “direct positive and negative performance feedback,” “direct, immediate feedback about the policy”

Unclear

Unclear

•Education

•Administrative (protocol/policy)

•Opinion leader

•“Barriers” (ordering this test required a justification and conversation with the laboratory consultant; colleagues were encouraged to challenge inappropriate orders)

Unclear (all staff types mentioned)

Hendryx 1998

USA [59]

Written and verbal

Face-to-face feedback meeting, reports

Group, unclear if individual

Lab test ordering:

Face-to-face: unclear; “reviewed the findings, and offered concrete, practical suggestions for improvement”

Reports: “percentage of processes successfully done, number of patients treated and their length of stay and discharge status, and occurrence of nosocomial events”

1

N/A

•Education (newsletter, seminars)

•Telephone consultation service

All providers

Merlani 2001 and Diby 2005

Switzerland [60, 61]

Written

“Time series charts, displayed on walls, and published in the unit information bulletin”

Group

Lab test ordering: Adherence, ABGs per patient day

20

Monthly

•Education

•Guidelines (Algorithm)

Physicians, physicians in-training, nurses, nurses in-training

Beland 2003

USA [62]

Written and verbal

“In-service training sessions”, handouts, posters

NR

Lab test ordering: “findings of the audit”; “laboratory charges,” “rate of unordered tests”

Unclear

NR

• Guidelines

• Opinion Leader

• Discussion on reducing hospital costs to save nurse positions

• “new processes”

Nurses and unclear (“medical staff”, “healthcare staff members”)

Wisser 2003

Germany [63]

Written

“Sent together with the laboratory results”

NR (patient-level data)

Lab test ordering: “cumulative diagnostic blood loss”

Unclear (multiple)

Daily

Unclear

Physicians

Petäjä 2004

Finland [64]

Verbal

“presented and discussed at a staff meeting”

NR

Transfusion ordering: Unclear; “Results of PI and PII,” “justifications of and goals for change”

1

N/A

• Administrative (on-line auditing system)

Physicians, physicians in-training

Calderon-Margalit 2005

Israel [65]

Written

Letter; “sent to the wards and reviewed with senior medical staff”

Group; unclear if individual (NR)

Lab test ordering: “overall institutional reduction in requests for all clinical biochemistry tests, as well as data on their specific ward’s reduction in testing”

1

N/A

• Education

• Administrative (policy)

Unclear (“heads of all the wards”, “senior medical staff”)

Schramm 2011

USA [51]

NR

NR

NR

Lab test and transfusion ordering: “compliance with the sepsis resuscitation bundle”

~ 84

Weekly

•Education & Order Set (also at baseline)

•Sepsis Response Team activation

Unclear (“healthcare providers”)

Masud 2011

USA [52]

Written, unclear if verbal component (NR)

Letters & unclear (“sharing data”)

NR

Transfusion ordering: “number of units transfused”, “transfusions…outside of the recommended guidelines”, “outcomes”

Unclear (multiple)

Feedback: Monthly and quarterly

Educational Letter: Depends on recipient

• Education

• Formation of transfusion committees

Unclear, Educational letters: Physicians

Arnold 2011

Canada [53]

NR

NR

Group; unclear if individual

Transfusion ordering: “general rates of inappropriate FP use,” “rates of inappropriate FP use after each of their weeks on service”

Unclear

NR

•Education

•Administrative (request form required indication, prompt if not completed)

Physicians, nurses

Beaty 2013

USA [54]

Verbal, unclear if written component (NR)

“publicly at a weekly cardiac surgical division meeting”

Group and individual

Transfusion ordering: Protocol adherence (exact details unclear)

17

Weekly

• Administrative (Protocol/ restriction of who could order)

*Note: Only A&F alone intervention

Physicians, physicians in-training

Gutsche 2013

USA [55]

Verbal, unclear if written component (NR)

“Feedback interviews and re-education”

NR

Transfusion ordering: Unclear

Unclear;

“in the case of guideline noncompliance”

Variable (depends on recipient)

• Guideline

• Education

• Administrative (closing of the unit)

Physicians, physicians in-training, nurses, other (physician assistants)

Yeh 2015

USA [56]

Written

Email & reports

Individual and group

Transfusion ordering: Details of transfusion events; summaries of transfusion activity

Individual: Unclear (variable, depends on recipient; 16 were sent in total)

Group: 6

Individual: Unclear (depends on recipient; “within 72 h of transfusion”)

Group: monthly

• Education

Physicians, physicians in-training

Murphy 2016

USA [57]

Written

Reports

Group

(“Unit-level”)

Lab test & transfusion ordering: “Change in utilization” (ABGs and RBCs)

12

Monthly

• Education

• Opinion Leaders

• Financial Incentives

Unclear (“ICUs”)

Borgert 2016

Netherlands [16]

Arm 1: Written

Arm 2: Written and verbal

Arm 1: Emailed report, posters

Arm 2: Emailed report, posters, “face-to-face contact” (report)

Arm 1: group

Arm 2: group and individual

Transfusion ordering:

Arm 1: “Compliance levels per team”

Arm 2: “Compliance levels per team”; “Compliance levels of the complete bundle and compliance per element”

Group: 4

Individual: unclear (for every transfusion ordered); overall= 40 “face-to-face contact” and 84 e-mails

Group: monthly

Individual: varied but “within 72 h after each RBC transfusion”

• Education

• Bundle/Checklist

Nurses

  1. ABG arterial blood gas, FP frozen plasma, ICU intensive care unit, N/A not applicable, NR not reported, PI period one, PII period two, RBC red blood cell