Using audit and feedback to change practice: Embedding clinical practice guidelines in acquired brain injury rehabilitation

Ms Laura Jolliffe1,2, Ms Rebecca Nicks2, A/Prof Natasha Lannin1,2, Prof Tammy Hoffmann3, Ms. Jacqui Morarty1

1La Trobe University, Melbourne, Australia

2Alfred Health, Melbourne, Australia

3Bond University, Gold Coast, Australia


AIM: To evaluate the effects of a sustained program of audit-feedback on therapists’ adherence to acquired brain injury (ABI) rehabilitation CPGs.


METHOD: Using a periodic service review method, inpatient rehabilitation care was audited fortnightly for 46 weeks (61 cases) against ABI rehabilitation CPGs (137 observable criteria), using medical record review, observation, and staff, patient and family interviews. Each fortnight, a facilitator-led multidisciplinary feedback session provided clinicians with a summary of observed adherence to CPGs, and positive behaviour feedback strategies were used to encourage clinicians to assess and adjust their performance. Three months after withdrawal of the audit-feedback, 20 randomly selected cases were audited to determine if adherence to CPGs was maintained.


RESULTS: Immediately following the intervention, there was a significant improvement in adherence to CPG criteria from 47% to 82% (35% improvement, 95% CI 25 to 46) (p=0.0001). Three months after intervention withdrawal adherence was lower and reduced to 73% (9% reduction, 95% CI -19 to 0.5) (p=0.002). Details of the clinical practice areas more susceptible to feedback withdrawal will be discussed.


SIGNIFICANCE OF FINDINGS TO ALLIED HEALTH: There are gaps between clinical practice guideline (CPG) recommendations and clinical practice provided. Studies outside of rehabilitation suggest audit and feedback is an effective behaviour-change intervention, however rehabilitation studies have demonstrated only minimal improvements. Our study demonstrates that intensive audit and feedback can improve adherence to rehabilitation CPGs. For sustainable change, audit and feedback needs to be incorporated into usual rehabilitation processes.