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A qualitative study of the variable effects of audit and feedback in the ICU
  1. Tasnim Sinuff1,2,
  2. John Muscedere3,
  3. Linda Rozmovitz4,
  4. Craig M Dale5,
  5. Damon C Scales1,2
  1. 1Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  2. 2Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Medicine and Critical Care Program, Queens University, Kingston General Hospital, Kingston, Ontario, Canada
  4. 4Independent Qualitative Researcher, Toronto, Ontario, Canada
  5. 5Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Tasnim Sinuff, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada M4N 3M5; taz.sinuff{at}sunnybrook.ca

Abstract

Background Audit and feedback is integral to performance improvement and behaviour change in the intensive care unit (ICU). However, there remain large gaps in our understanding of the social experience of audit and feedback and the mechanisms whereby it can be optimised as a quality improvement strategy in the ICU setting.

Methods We conducted a modified grounded theory qualitative study. Seventy-two clinicians from five academic and five community ICUs in Ontario, Canada, were interviewed. Team members reviewed interview transcripts independently. Data analysis used constant comparative methods.

Results Clinicians interviewed experienced audit and feedback as fragmented and variable in its effectiveness. Moreover, clinicians felt disconnected from the process. The audit process was perceived as being insufficiently transparent. Feedback was often untimely, incomplete and not actionable. Specific groups such as respiratory therapists and night-shift clinicians felt marginalised. Suggestions for improvement included improving information sharing about the rationale for change and the audit process, tools and metrics; implementing peer-to-peer quality discussions to avoid a top-down approach (eg, incorporating feedback into discussions at daily rounds); providing effective feedback which contains specific, transparent and actionable information; delivering timely feedback (ie, balancing feedback proximate to events with trends over time) and increasing engagement by senior management.

Conclusions ICU clinicians experience audit and feedback as fragmented communication with feedback being especially problematic. Attention to improving communication, integration of the process into daily clinical activities and making feedback timely, specific and actionable may increase the effectiveness of audit and feedback to affect desired change.

  • Audit and feedback
  • Implementation science
  • Qualitative research
  • Quality improvement

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