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 | 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 |