The time relationship of performance and audit feedback on conformance with emergency department process criteria

Adherence to physician-developed process criteria is critical to the medical and legal acceptance of algorithm-directed nonphysician care of acute non-life-threatening illnesses seen in the emergency department. It is generally assumed that adherence to prescribed medical process criteria results in acceptable patient outcomes. We evaluated changes in compliance with varying time delays in audit feedback and varying degrees of supervision. Our evaluation indicated that, under ideal circumstances of daily audit and supervisory feedback, a conformance rate of 80% was achieved. This is a 100% improvement over a group in which neither element was operative.