title: The value of audit and feedback reports in improving nutrition therapy in the intensive care unit: a multicenter observational study.
abstract: BACKGROUND
  The objective of this study was to determine whether auditing practice and providing feedback in the form of benchmarked site reports is an effective strategy to improve adherence to nutrition guidelines.
  
  
  METHODS
  The authors conducted a multicenter observational study in Canadian intensive care units (ICUs). In January 2007, an audit of daily nutrition information was collected (type and amount of nutrition received and strategies to improve nutrition delivery). Each ICU was e-mailed individualized benchmarked performance reports documenting their performance compared with the Canadian Critical Care Nutrition guidelines and in relation to the other ICUs. Nutrition practice was reaudited in May 2008 to evaluate changes in practice.
  
  
  RESULTS
  Twenty-six ICUs in Canada participated, with 473 and 486 patients accrued in 2007 and 2008, respectively. The authors observed a significant increase in enteral nutrition (EN) adequacy (from 45.1% to 51.9% for calories, and from 44.8% to 51.5% for protein) and an increase in the percentage of patients receiving EN without parenteral nutrition (from 71.9% to 81.3%). They also observed trends toward improvements in the percentage of patients who had EN started within 48 hours (from 60.3% to 66.8%). There were no significant differences in the use of motility agents or small bowel feeding in patients who had high gastric residual volumes.
  
  
  CONCLUSIONS
  Audit and feedback reports are associated with improvement in some nutrition practices in many ICUs; however, the magnitude of these effects is quite modest. More research is needed to determine the optimal methods of using audit and feedback to improve quality of nutrition care.
authors.affiliation: Department of Critical Care Medicine, University of Toronto, Ontario, Canada.
authors.forename: Tasnim
authors.initials: T
authors.lastname: Sinuff
authors.forename: Naomi E
authors.initials: NE
authors.lastname: Cahill
authors.forename: Rupinder
authors.initials: R
authors.lastname: Dhaliwal
authors.forename: Miao
authors.initials: M
authors.lastname: Wang
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Day
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D019985:Benchmarking; D002170:Canada; D003422:Critical Care / Q000592:standards / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data; D008485:Medical Audit; D044623:Nutrition Therapy / Q000592:standards* / Q000706:statistics & numerical data; D019370:Observation; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000706:statistics & numerical data*