Are current audit and feedback interventions to change UK blood transfusion practice theory- and evidence-based?

Abstract

Background: Audit and feedback (A&F) is a widely used healthcare quality improvement intervention. Although A&F can be effective, outcomes are heterogeneous. Applying behavioural theories and evidence can guide design of A&F. This study applied behavioural theory and evidence to specify feedback components and characteristics used in an established UK national comparative audit (NCA) programme targeting transfusion practice. This NCA’s approach to A&F has remained largely unchanged since its establishment fifteen years ago. Methods: A structured content analysis of 12 existing feedback reports was conducted, applying a coding framework to specify intervention content in terms of component behaviour change techniques (BCTs). Reports were coded for 11 BCTs consistent with Control Theory of behavioural regulation (e.g.‘review goals,’ ‘discrepancy,’ ‘action planning’) and six feedback characteristics with demonstrated effectiveness in an A&F Cochrane review (e.g.verbal and written format; repeated/frequent feedback, inclusion of peer average/achievable bench mark [top 10%] comparators). Results: Reports included 3 to 14 BCTs (mean: 8). Reports contained on average 4.5 (41%) BCTs consistent with Control Theory (range: 2-7; most frequent: ‘feedback on behaviour’ [n=11 reports];’ least frequent: ‘review goals’ [n=0]), and 1.4 (23%) evidence-based feedback characteristics (range: 0-3; most frequent: ‘peer comparison- average’ [n=7], least: ‘verbal + written format,’ ‘peer/supervisor source,’ ‘frequent/repeated’ [n=0]). Conclusion: Our findings suggest current feedback reports do not optimally include theory and evidence-based feedback characteristics likely to increase their effectiveness. There is thus scope to apply behavioural theory and evidence to enhance feedback provided in transfusion NCAs, in order to improve practice and, thus, patient outcomes.