Audit and feedback: effects on professional practice and health-care outcomes
RHL practical aspects by Pattinson RC
FIRST CONTACT (PRIMARY CARE) LEVEL
Information is vital for the effective management of all care facilities in a health system. Hence, audit and feedback should be performed at all levels of care. Regardless of the size of the primary level facility, all health-care professionals in it should be involved in audit and feedback process and this should be regarded as contributing to audit and feedback of the larger health system.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
If audit and feedback is being initiated for the first time, it would be easiest to start with maternal and perinatal death reviews. Identifying maternal and perinatal deaths in an institution is relatively simple, and the cases can be presented at maternal and perinatal mortality meetings. Beyond the numbers: reviewing maternal deaths and complications to make pregnancy safer (1) is an excellent manual and will help those implementing a maternal death review.
When a referral hospital conducts an audit and feedback exercise related to issues (such as maternal and perinatal deaths and developing protocols) that concern the facilities that use the hospital at a referral centre, the referral hospital must involve professionals from the lower level health facilities. Concerned health administrators and clinical staff at all levels must be included in the audit and feedback process. Ideally notes should be kept of all meetings held in order to document decisions and tasks allocated. Feedback should be obtained on the progress in performing those tasks at follow-up meetings. The educational content of the meetings is usually dictated by the problems identified by the audit. In outcomes and process audits the names of individuals are withheld to ensure that the process does not become a witch-hunt.
AT HOME OR IN THE COMMUNITY
- Beyond the numbers: reviewing maternal deaths and complications to make pregnancy safe. Geneva, World Health Organization;2004.
This document should be cited as: Pattinson RC. Audit and feedback: effects on professional practice and health-care outcomes: RHL practical aspects (last revised: 15 December 2006). The WHO Reproductive Health Library; Geneva: World Health Organization.