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Improving emergency physician performance using audit and feedback: a systematic review.

R Le Grand Rogers1, Yizza Narvaez1, Arjun K Venkatesh2

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Audit and feedback interventions in the emergency department (ED) show significant improvements in physician performance. Key intervention characteristics include explicit, measurable feedback targeting omission errors, delivered over a week after performance.

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Area of Science:

  • Emergency Medicine
  • Health Services Research
  • Quality Improvement

Background:

  • Audit and feedback are established methods for reducing variation and enhancing care quality across healthcare settings.
  • Existing literature on audit and feedback in emergency departments (EDs) is growing but often comprises small studies lacking focus on specific clinical processes.
  • Systematic assessment is needed to determine the overall effectiveness of ED-based audit and feedback interventions and identify crucial success factors.

Purpose of the Study:

  • To systematically evaluate the impact of audit and feedback interventions on emergency physician performance.
  • To identify specific characteristics of audit and feedback that are critical for successful implementation and improved outcomes in the ED.

Main Methods:

  • A systematic review adhering to the PRISMA statement was conducted, searching major databases (Medline, EMBASE, PsycINFO, PubMed) for studies from January 1994 to January 2014.
  • Included studies focused on emergency departments, utilized both audit and feedback components, and reported quantitative outcomes. Methodological quality was assessed using the Downs and Black checklist.
  • Meta-analysis and heterogeneity assessment (I2 index) were planned for studies with sufficient outcome data.

Main Results:

  • The review identified 24 studies meeting inclusion criteria, with an average methodological quality score of 15.6/30.
  • Twenty-three of the 24 studies reported improved physician performance.
  • Meta-analysis of six studies involving 41,124 patients indicated an average treatment effect of 36% (SD, 16%), with high heterogeneity (I2=83%).

Conclusions:

  • Audit and feedback interventions demonstrate positive effects across various clinical conditions in the ED, though reporting standardization for meta-analysis is insufficient.
  • Common successful intervention characteristics included feedback targeting omission errors, explicit measurable instructions, plans for change, delivery >1 week post-performance, and multi-modal, multi-level feedback (individual and group).
  • Future research should prioritize standardized reporting to elucidate specific audit and feedback components driving effectiveness in emergency care.