Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic review
Abstract Background Laboratory tests and transfusions are sometimes ordered inappropriately, particularly in the critical care setting, which sees frequent use of both. Audit and Feedback (A&F) is a potentially useful intervention for modifying healthcare provider behaviors, but its application...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13012-020-00981-5 |
| _version_ | 1819050680456839168 |
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| author | Madison Foster Justin Presseau Nicola McCleary Kelly Carroll Lauralyn McIntyre Brian Hutton Jamie Brehaut |
| author_facet | Madison Foster Justin Presseau Nicola McCleary Kelly Carroll Lauralyn McIntyre Brian Hutton Jamie Brehaut |
| author_sort | Madison Foster |
| collection | DOAJ |
| description | Abstract Background Laboratory tests and transfusions are sometimes ordered inappropriately, particularly in the critical care setting, which sees frequent use of both. Audit and Feedback (A&F) is a potentially useful intervention for modifying healthcare provider behaviors, but its application to the complex, team-based environment of critical care is not well understood. We conducted a systematic review of the literature on A&F interventions for improving test or transfusion ordering in the critical care setting. Methods Five databases, two registries, and the bibliographies of relevant articles were searched. We included critical care studies that assessed the use of A&F targeting healthcare provider behaviors, alone or in combination with other interventions to improve test and transfusion ordering, as compared to historical practice, no intervention, or another healthcare behaviour change intervention. Studies were included only if they reported laboratory test or transfusion orders, or the appropriateness of orders, as outcomes. There were no restrictions based on study design, date of publication, or follow-up time. Intervention characteristics and absolute differences in outcomes were summarized. The quality of individual studies was assessed using a modified version of the Effective Practice and Organisation of Care Cochrane Review Group’s criteria. Results We identified 16 studies, including 13 uncontrolled before-after studies, one randomized controlled trial, one controlled before-after study, and one controlled clinical trial (quasi-experimental). These studies described 17 interventions, mostly (88%) multifaceted interventions with an A&F component. Feedback was most often provided in a written format only (41%), more than once (53%), and most often only provided data aggregated to the group-level (41%). Most studies saw a change in the hypothesized direction, but not all studies provided statistical analyses to formally test improvement. Overall study quality was low, with studies often lacking a concurrent control group. Conclusions Our review summarizes characteristics of A&F interventions implemented in the critical care context, points to some mechanisms by which A&F might be made more effective in this setting, and provides an overview of how the appropriateness of orders was reported. Our findings suggest that A&F can be effective in the context of critical care; however, further research is required to characterize approaches that optimize the effectiveness in this setting alongside more rigorous evaluation methods. Trial registration PROSPERO CRD42016051941 . |
| first_indexed | 2024-12-21T11:51:54Z |
| format | Article |
| id | doaj.art-66a064b5d9844059bac21304c54cbcda |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-12-21T11:51:54Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-66a064b5d9844059bac21304c54cbcda2022-12-21T19:05:02ZengBMCImplementation Science1748-59082020-06-0115111810.1186/s13012-020-00981-5Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic reviewMadison Foster0Justin Presseau1Nicola McCleary2Kelly Carroll3Lauralyn McIntyre4Brian Hutton5Jamie Brehaut6School of Epidemiology and Public Health, University of OttawaSchool of Epidemiology and Public Health, University of OttawaSchool of Epidemiology and Public Health, University of OttawaOttawa Hospital Research Institute, Clinical Epidemiology Program, The Ottawa Hospital, General CampusSchool of Epidemiology and Public Health, University of OttawaSchool of Epidemiology and Public Health, University of OttawaSchool of Epidemiology and Public Health, University of OttawaAbstract Background Laboratory tests and transfusions are sometimes ordered inappropriately, particularly in the critical care setting, which sees frequent use of both. Audit and Feedback (A&F) is a potentially useful intervention for modifying healthcare provider behaviors, but its application to the complex, team-based environment of critical care is not well understood. We conducted a systematic review of the literature on A&F interventions for improving test or transfusion ordering in the critical care setting. Methods Five databases, two registries, and the bibliographies of relevant articles were searched. We included critical care studies that assessed the use of A&F targeting healthcare provider behaviors, alone or in combination with other interventions to improve test and transfusion ordering, as compared to historical practice, no intervention, or another healthcare behaviour change intervention. Studies were included only if they reported laboratory test or transfusion orders, or the appropriateness of orders, as outcomes. There were no restrictions based on study design, date of publication, or follow-up time. Intervention characteristics and absolute differences in outcomes were summarized. The quality of individual studies was assessed using a modified version of the Effective Practice and Organisation of Care Cochrane Review Group’s criteria. Results We identified 16 studies, including 13 uncontrolled before-after studies, one randomized controlled trial, one controlled before-after study, and one controlled clinical trial (quasi-experimental). These studies described 17 interventions, mostly (88%) multifaceted interventions with an A&F component. Feedback was most often provided in a written format only (41%), more than once (53%), and most often only provided data aggregated to the group-level (41%). Most studies saw a change in the hypothesized direction, but not all studies provided statistical analyses to formally test improvement. Overall study quality was low, with studies often lacking a concurrent control group. Conclusions Our review summarizes characteristics of A&F interventions implemented in the critical care context, points to some mechanisms by which A&F might be made more effective in this setting, and provides an overview of how the appropriateness of orders was reported. Our findings suggest that A&F can be effective in the context of critical care; however, further research is required to characterize approaches that optimize the effectiveness in this setting alongside more rigorous evaluation methods. Trial registration PROSPERO CRD42016051941 .http://link.springer.com/article/10.1186/s13012-020-00981-5AuditFeedbackIntensive CareCritical CareLaboratory UtilizationTest Use |
| spellingShingle | Madison Foster Justin Presseau Nicola McCleary Kelly Carroll Lauralyn McIntyre Brian Hutton Jamie Brehaut Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic review Implementation Science Audit Feedback Intensive Care Critical Care Laboratory Utilization Test Use |
| title | Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic review |
| title_full | Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic review |
| title_fullStr | Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic review |
| title_full_unstemmed | Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic review |
| title_short | Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic review |
| title_sort | audit and feedback to improve laboratory test and transfusion ordering in critical care a systematic review |
| topic | Audit Feedback Intensive Care Critical Care Laboratory Utilization Test Use |
| url | http://link.springer.com/article/10.1186/s13012-020-00981-5 |
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