Using audit and feedback to increase clinician adherence to clinical practice guidelines in brain injury rehabilitation: A before and after study

OBJECTIVE: This study evaluated whether frequent (fortnightly) audit and feedback cycles over a sustained period of time (>12 months) increased clinician adherence to recommended guidelines in acquired brain injury rehabilitation. DESIGN: A before and after study design. SETTING: A metropolitan inpatient brain injury rehabilitation unit. PARTICIPANTS: Clinicians; medical, nursing and allied health staff. INTERVENTIONS: Fortnightly cycles of audit and feedback for 14 months. Each fortnight, medical file and observational audits were completed against 114 clinical indicators. MAIN OUTCOME MEASURE: Adherence to guideline indicators before and after intervention, calculated by proportions, Mann-Whitney U and Chi square analysis. RESULTS: Clinical and statistical significant improvements in median clinical indicator adherence were found immediately following the audit and feedback program from 38.8% (95% CI 34.3 to 44.4) to 83.6% (95% CI 81.8 to 88.5). Three months after cessation of the intervention, median adherence had decreased from 82.3% to 76.6% (95% CI 72.7 to 83.3, p<0.01). Findings suggest that there are individual indicators which are more amenable to change using an audit and feedback program. CONCLUSION: A fortnightly audit and feedback program increased clinicians’ adherence to guideline recommendations in an inpatient acquired brain injury rehabilitation setting. We propose future studies build on the evidence-based method used in the present study to determine effectiveness and develop an implementation toolkit for scale-up.