Key messages

- Audit and feedback in healthcare is when a health professional's performance is evaluated and compared to professional standards (audit). Then the health professionals are given the results of the comparison (feedback), with the hope that it might help them improve their performance.

- Audit and feedback helps to improve health professional performance a little to a moderate amount. It works best when it shows health professionals how they compare to top performers, focuses on important areas for improvement, and includes tips for making changes. Audit and feedback can be even more helpful when combined with other supports like reminders or extra training.

- Future research should focus on finding the best ways to improve audit and feedback interventions.

What is meant by audit and feedback in healthcare?

Audit and feedback is often used in healthcare organisations to improve healthcare professionals’ performance. In an audit and feedback process, an individual’s professional practice or performance is measured and then compared to professional standards or targets. In other words, their professional performance is “audited”. During the "feedback", the results of this comparison are then provided to health professionals. The aim of this process is to encourage healthcare professionals to take action or make changes to follow standards.

What did we do?

We searched for all the studies in which healthcare professionals were randomised to receive audit and feedback and in which the results on professional practice were measured.

What did we find?

We found 292 studies that met the requirements. We found that audit and feedback is often used together with other strategies to improve quality of care, such as educational meetings or reminders. Most studies measured the effect of audit and feedback on doctors, although some studies measured the effect on nurses or pharmacists. Audit and feedback was used to influence their performance in different areas, including the proper use of prescription treatments or test-ordering.

The exact way that audit and feedback was delivered varied widely across the studies. Sometimes health professionals were given feedback verbally, other times in writing, on an electronic dashboard or through multiple modes. In some studies, this feedback was given to them by the researchers responsible for the study, while in other studies, feedback was given by supervisors or colleagues. In some studies, health professionals were given feedback only once, while others were given feedback monthly. Sometimes, they were also given or supported to create an action plan with suggestions or advice about how to improve their performance.

Main results: What happens when health professionals are audited and provided with feedback?

The effect of using audit and feedback varied widely across the included studies, but most often it achieves small-to-moderate improvements in quality of care.

Audit and feedback may be most effective when recipients can see how their own performance compares to their high-performing peers, when it helps the health professional to identify and take action on high-priority clinical issues, and when it focuses on areas where health professionals have substantial room for improvement. Other features of audit and feedback that are associated with greater effects are when it involves measurement of the individual recipient's practice (rather than their team or organisation); comes from a respected peer with an existing relationship to the recipient; includes multiple modalities (e.g., verbal and written); and features an action plan with advice for improvement.

In addition, the effect of audit and feedback may change when combined with other strategies that support improved quality of care, such as education or reminders.

What are the limitations of the evidence?

The quality of the evidence is moderate and further research is needed to confirm the features of audit and feedback that are most likely to achieve the greatest effects in different situations.

How up to date is this evidence?

This review updates our previous review. The evidence analysed is up-to-date to June 2020.