Changing surgical practice through feedback of performance data.
BACKGROUND
Changing health care practice is commonly attempted by feedback of performance data measured by clinical audit. However, empirical evidence of the effectiveness of clinical audit in changing practice is limited. Few studies have attempted to evaluate practice development or clinical outcomes within the conceptual framework of change theory. Several published studies have used passive feedback in an attempt to promote a change in practice. Sending information to health care workers on their performance is one of the simplest ways of attempting to change performance.


OBJECTIVE
To evaluate the impact on infection rates of the passive feedback of surgical wound infection rate data to nurses and surgeons within an empirical rational approach to change, and the active feedback of data within a normative re-educative approach to change.


METHODS
A prospective cohort study over a 3-year period of all surgical patients undergoing clean elective surgery (n = 2241). Patients were monitored whilst an inpatient and up to 30 days postoperatively by an independent observer to determine surgical wound infection rates. The method employed was 'gold standard' surveillance, whereby patients were followed up into the community setting.


METHODS
Interventions of feedback and withdrawal of feedback of infection rate data and introduction of guidelines for evidence-based surgical practice within a change theory framework were monitored by the incidence of infection during the periods of the particular intervention.


RESULTS
Although the feedback of infection rate data impacted on the subsequent infection rates, the reduction was not statistically significant. However, a significant reduction in the infection rates was achieved following the introduction of guidelines for best surgical practice (P < 0.05).


CONCLUSIONS
The findings indicate that if change in practice is to be achieved by the feedback of performance data, then the process of feedback should be active and within a normative re-educative approach to change.
Reilly
Jacqueline
J
Lanarkshire Acute Hospitals NHS Trust, Lanarkshire, UK. jacquireilly@yahoo.co.uk
McIntosh
Jean
J
Currie
Kay
K
D013502:General Surgery / Q000592:standards*; D017408:Guidelines as Topic; D006801:Humans; D007721:Knowledge of Results, Psychological; D008485:Medical Audit; D011364:Professional Practice / Q000592:standards; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000145:classification / Q000453:epidemiology*; D013647:Task Performance and Analysis