Background and Objective:
Due to the complexity in management of acute myocardial infarction (AMI) and ischemic stroke, the Lazio region (Italy) realized an emergency network, involving different hospitals and emergency care providers. Although Audit&Feedback (A&F) is often the foundation of multidimensional quality improvement activities, the optimal design is still unknown. This work reports the dynamics in development and implementation of an A&F intervention to improve appropriateness and timeliness of emergency care for AMI and stroke, within the EASY-NET research program (NET-2016-02364191).

Methods:
All the emergency network hospitals were invited to participate. An expert team was involved in a two rounds Delphi survey to identify a set of indicators to evaluate AMI and stroke care pathways. The way for feedback reporting was defined through a web-based survey including objective and subjective assessment of clarity, completeness, and comprehensibility of different proposals. Starting from literature, a form to collect information on Audit conduction and provide a guide was developed. In the end, a controlled pre-post study will be performed. The control group has public access to a regional web platform that periodically updates the same indicators.

Results:
A total of 18 hospitals have joined the intervention group. The Delphi procedure validated the final set of indicators (11 for AMI and 16 for stroke). Two feedback reports were delivered. Additionally, an evidence-based Audit form was developed and disseminated to collect information on Audit characteristics (team composition, main audit process activities, improvement action proposed and timing for the implementation). Several hospitals organized the audit and returned the form to the research group.

Conclusion:
At this point, we learned that sharing methods and instruments with the target increases the acceptability of the intervention. Strong collaboration with the stakeholders keeps the interest high and reduces drop-outs. Staying informed about audits conducted at hospitals remains an open challenge.