Timely individual audit and feedback significantly improves transfusion bundle compliance—a comparative study

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To investigate the difference in effect on transfusion bundle compliance between two Audit and Feedback (A&F) strategies to implement the transfusion bundle.

Design and setting

This implementation study was conducted in an ICU of a university hospital from May to December 2014. The ICU consists of two nursing teams containing 63 and 62 nurses.


All ICU nurses participated in this study.


Monthly A&F on team level versus a combination of monthly A&F on team level plus timely individual feedback.


The primary outcome was bundle compliance. Compliance was measured after every single transfusion.


Monthly A&F on team level with timely individual A&F significantly improves bundle compliance during implementation compared to monthly A&F on team level alone. The overall effect of compliance during the study period was significantly higher with an OR of 4.05 (95% confidence interval, CI: 1.62 to 10.08), P < 0.001. This indicates that when using the combined A&F strategy nurses are more likely to be compliant to the bundle than when monthly A&F was used alone.


Compared to monthly team A&F alone, providing timely individual A&F plus monthly A&F on team level significantly improves the success of implementing a transfusion bundle on the ICU during the implementation period. Providing timely individual A&F plus monthly A&F on team level might also be effective for the implementation of other bundles in healthcare. Future research could elaborate on longer duration of the intervention, the use of information and computer technology to lower costs of the intervention, and to enhance sustainability.

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