Examples of feedback
Feedback mandates comparison of current behaviour with past behaviour or with others’ behaviour or with a standard.
Therefore, defining process and outcome measures are key in understanding and interpreting quality improvement and stewardship projects and are pivotal for standardised measurement and feedback to front-line stewards:
Process measures relates to
• How do your prescribers diagnose and manage infections?
• How, when, at what dose and for how long do your doctors use antibiotics and the anti fungal agents?
Outcome measures relate to impact of the process, i.e. results
• Does the process make a difference to your results?
• What are the favourable results in your hospital (e.g shortened stay in ICU or other benefits)?
• Conversely, what are the unfavourable consequences? Is it safe?
- The change in antimicrobial usage is the most common outcome measured in studies of stewardship programs (e.g quantity of total antimicrobial use, quantity of targeted antimicrobial use, duration of therapy etc).
Aalaa Afdal mentioned these measures in her video in Step 3.8.
Process indicators are easier to measure but outcome is more important and improvements or otherwise for both metrics should be included in regular feedback.
The table below shows an example of core measures and indicators for feedback in the peri-operative antibiotic prophylaxis improvement model in South Africa.
Step 3.15 provides more detail to understand how feedback changes behaviour.
What measure(s) (process and/or outcome) for feedback in your hospital would make your prescribers support you and your stewardship program, and why do think that will be the case?
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