HEALTHCARE QUALITY PAGE

The updated Cochrane review on audit and feedback (A&F) concludes that ‘... there remains uncertainty regarding the effects of A&F on improving healthcare practice and the characteristics of A&F that lead to a greater impact.’ Although the review has moved away from describing audit simply as ‘a summary of clinical performance over a specified period of time,’ it still presents audit as measuring quality of care against standards and feeding back a summary report to relevant healthcare professionals. Most healthcare professionals would expect clinical audit to go further: using the data to change practice and improve quality when needed.

 

Several issues limit the usefulness of the review for understanding the potential of the clinical audit process:

• It uses the wrong paradigm for the audit process, presenting audit as collecting and reporting data about patient care, without expecting action on what the data reveal.

• It relies only on randomized controlled trials, overlooking other forms of evidence about the effectiveness of audit, including evidence from national clinical audits.

• It includes studies published only up to June 2020 and excludes 61 studies published between 2020 and 2024 that qualified for inclusion.

• It focuses mainly on studies of processes of care carried out by individual healthcare professionals and doesn’t emphasize patient outcomes or refer to audits carried out by other healthcare professionals.

• It is out-of-touch with current systems-based thinking about improvement, including the reality that individual professionals may have limited ability to change practice when poor quality care is caused by system problems.

 

There will be no further Cochrane reviews focused generically on audit and feedback. Future reviews are expected to focus on more specific questions about the audit process. A new approach is welcome if it moves the emphasis away from feedback and towards how audit can be used as a quality improvement process.