What are the limits to the use of audit and feedback in quality improvement? A critical reflection

Audit and feedback is widely used across health care settings. It can be relatively inexpensive and drive improvement at scale. However, like other quality improvement interventions, audit and feedback carries the risk of unintended consequences and potential harms to patients, health professionals, and health care systems—for example, by wasting resources. There is a lack of clarity about the circumstances and contexts in which audit and feedback should not be delivered. We critically reflect on the limits, or what we will refer to as boundary conditions , to the use of audit and feedback. We propose boundary conditions to support decision-making by quality improvement leaders, clinicians, and researchers about the use of audit and feedback for quality improvement to optimize the use of scarce health care resources, maximize benefit, and reduce the risk of harms. Spanish abstract: https://links.lww.com/IJEBH/A717