Audit and feedback is defined as “any summary of clinical performance of health care over a specified period of time” given in a written, electronic, or verbal format.

Chart Audits

In chart audits, documented clinical care is measured against a review criterion, defined as, “a systematically developed statement that can be used to assess the appropriateness of specific health care decisions, services, and outcomes.”

Review criteria are often derived from clinical guideline recommendations and aim to maximize the reliability and objectivity of measurement. Review criteria can relate to the structure of health care delivery, health care processes, and patient outcomes. Structural and process criteria must be valid, so that strong evidence exists that their improvement is associated with improvement in outcomes of care. Outcome criteria tend to be less sensitive to changes in practice, because many factors may influence patient outcomes.

Audit and Feedback

The mechanism by which audit and feedback works appears self-evident, demonstrating the gap between actual and desired performance will motivate clinicians or health care systems to take action to address that gap. The theory that is most relevant to this process is self-regulation theory. “Self-regulation” is a process of determining goals and then using these as reference values to bring existing states into line with those goals. The success of any desired change also depends upon individuals being able to change their behaviour or upon external influences on behaviour. The delivery of feedback can vary according to the following:

  • Type of Format
  • Frequency and Duration
  • Source
  • Content
  • Use of Various Sources

Feedback may be more effective when the source is a supervisor or colleague, it is provided more than once, it is delivered in both verbal and written formats, and it includes both explicit targets and an action plan. There is limited evidence that combining audit and feedback with other strategies, such as educational meetings, is more effective than audit and feedback alone.