SynthesisPloS one2021
Understanding how and why audits work in improving the quality of hospital care: A systematic realist review.
Synthesis in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 94 citations in OpenAlex.
- Sustained Improvement in Urine Testing Quality Indicator Through an Audit-and-Feedback Intervention in Japanese Primary Care: A Before-and-After Study.Journal of general and family medicine · 2026Article
- Perceptions of Medical Malpractice Liability and Informed Consent Among Hospital Healthcare Workers: A Cross-Sectional Study.Healthcare (Basel, Switzerland) · 2026Article
- Contextual Determinants of Clinical Pharmacists' Contributions to Team-Based Antimicrobial Stewardship in Jordanian Hospitals: A Realist-Informed Qualitative Study.Antibiotics (Basel, Switzerland) · 2026Article
- Developing quality improvement awareness, skills, and emerging leadership behaviors through clinical audits in postgraduate medical education.BMC medical education · 2026Article
- Perioperative patient safety: nurses' safety perceptions and observed compliance with safety standards in the operating room.BMC nursing · 2026Article
- Factors affecting the collection of clinical data for quality improvement at a tertiary centre in Papua New Guinea: a qualitative study.Journal of global health · 2026Article
- Audit on knowledge, attitudes and practices on developmental assessment among public health midwives in a sub-urban health area in Sri Lanka.BMC public health · 2026Article
- Assessment of the 5-year evaluation for 1st call members of the European Reference Network on Rare Endocrine Conditions (Endo-ERN).Endocrine connections · 2026Review
- Identifying barriers and facilitators to audit & feedback in general practice in Italy: a qualitative study.BMC health services research · 2026Article
- National survey of Australian endocrinologists on relative importance of pre-existing inpatient diabetes audit fields in preparation for a national hospital audit.BMC health services research · 2025Article
- Improving patient reported experience in inpatients with palliative care needs: a pre-post quality improvement study.BMC palliative care · 2025Article
- Maternity Healthcare Worker Perspectives of Severe Acute Maternal Morbidity Recording, Reporting and Case Review in Queensland, Australia.The Australian & New Zealand journal of obstetrics & gynaecology · 2025Article
- CRISPR and Artificial Intelligence in Neuroregeneration: Closed-Loop Strategies for Precision Medicine, Spinal Cord Repair, and Adaptive Neuro-Oncology.International journal of molecular sciences · 2025Review
- Green Surgery and Sustainability in Orthopaedic Operating Rooms: A Comprehensive Review of Environmental Initiatives.Cureus · 2025Review
- Implementation strategies of a national standard for comprehensive care in acute care hospitals: An interview study.International journal of nursing sciences · 2025Article
- Reducing global inequities in medical oxygen access: the Lancet Global Health Commission on medical oxygen security.The Lancet. Global health · 2025Review
- Clinical risk modeling and epidemiological surveillance of SARI in Cali, Colombia.Revista panamericana de salud publica = Pan American journal of public health · 2025Article
- How and why do community stakeholders participate in the national stroke audit in England? Findings from a mixed-method online survey.BMC health services research · 2024Article
- Internal Audit of an Oral Pathology Laboratory: Perspectives on Finances and Operational Management.Cureus · 2024Article
- Advisory groups in realist reviews: Systematically mapping current research and recommendations for practice.Cochrane evidence synthesis and methods · 2024Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSeveral types of audits have been used to promote quality improvement (QI) in hospital care. However, in-depth studies into the mechanisms responsible for the effectiveness of audits in a given context is scarce. We sought to understand the mechanisms and contextual factors that determine why audits might, or might not, lead to improved quality of hospital care.
methodsA realist review was conducted to systematically search and synthesise the literature on audits. Data from individual papers were synthesised by coding, iteratively testing and supplementing initial programme theories, and refining these theories into a set of context-mechanism-outcome configurations (CMOcs).
resultsFrom our synthesis of 85 papers, seven CMOcs were identified that explain how audits work: (1) externally initiated audits create QI awareness although their impact on improvement diminishes over time; (2) a sense of urgency felt by healthcare professionals triggers engagement with an audit; (3) champions are vital for an audit to be perceived by healthcare professionals as worth the effort; (4) bottom-up initiated audits are more likely to bring about sustained change; (5) knowledge-sharing within externally mandated audits triggers participation by healthcare professionals; (6) audit data support healthcare professionals in raising issues in their dialogues with those in leadership positions; and (7) audits legitimise the provision of feedback to colleagues, which flattens the perceived hierarchy and encourages constructive collaboration.
conclusionsThis realist review has identified seven CMOcs that should be taken into account when seeking to optimise the design and usage of audits. These CMOcs can provide policy makers and practice leaders with an adequate conceptual grounding to design contextually sensitive audits in diverse settings and advance the audit research agenda for various contexts. PROSPERO REGISTRATION: CRD42016039882.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.