Berger Zackary, Flickinger Tabor E, Pfoh Elizabeth, Martinez Kathryn A, Dy Sydney M
Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA.
Division of General Medicine, Geriatrics, and Palliative Care, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
BMJ Qual Saf. 2014 Jul;23(7):548-55. doi: 10.1136/bmjqs-2012-001769. Epub 2013 Dec 13.
Patient-centeredness is central to healthcare. Hospitals should address patients' unique needs to improve safety and quality. Patient engagement in healthcare, which may help prevent adverse events, can be approached as an independent patient safety practice (PSP) or as part of a multifactorial PSP.
This review examines how interventions encouraging this engagement have been implemented in controlled trials.
We searched Medline, CINAHL, Embase and Cochrane from 2000 to 2012 for English language studies in hospital settings with prospective controlled designs, addressing the effectiveness or implementation of patient/family engagement in PSPs. We separately reviewed interventions implemented as part of selected broader PSPs by way of example: hand hygiene, ventilator-associated pneumonia, rapid response systems and care transitions.
Six articles met the inclusion criteria for effectiveness with a primary focus on patient engagement. We identified 12 studies implementing patient engagement as an aspect of selected broader PSPs. A number of studies relied on patients' possible function as a reporter of error to healthcare workers and patients as a source of reminders regarding safety behaviours, while others relied on direct activation of patients or families. Definitions of patient and family engagement were lacking, as well as evidence regarding the types of patients who might feel comfortable engaging with providers, and in what contexts.
While patient engagement in safety is appealing, there is insufficient high-quality evidence informing real-world implementation. Further work should evaluate the effectiveness of interventions on patient and family engagement and clarify the added benefit of incorporating engagement in multifaceted approaches to improve patient safety endpoints. In addition, strategies to assess and overcome barriers to patients' willingness to actively engage in their care should be investigated.
以患者为中心是医疗保健的核心。医院应满足患者的独特需求，以提高安全性和质量。患者参与医疗保健有助于预防不良事件，可作为一种独立的患者安全实践（PSP）来实施，也可作为多因素PSP的一部分。
本综述探讨了在对照试验中如何实施鼓励这种参与的干预措施。
我们检索了2000年至2012年期间的Medline、CINAHL、Embase和Cochrane数据库，查找医院环境中采用前瞻性对照设计的英文研究，这些研究涉及患者/家属参与PSP的有效性或实施情况。我们分别审查了作为选定的更广泛PSP的一部分实施的干预措施，例如：手卫生、呼吸机相关性肺炎、快速反应系统和护理过渡。
六篇文章符合以患者参与为主要重点的有效性纳入标准。我们确定了12项将患者参与作为选定的更广泛PSP的一个方面来实施的研究。一些研究依赖于患者可能作为向医护人员报告错误的角色以及患者作为安全行为提醒来源的作用，而其他研究则依赖于直接激活患者或家属。缺乏患者和家属参与的定义，也缺乏关于哪些类型的患者可能愿意与医护人员互动以及在何种情况下互动的证据。
虽然患者参与安全很有吸引力，但缺乏高质量的证据为实际实施提供指导。进一步的工作应评估干预措施对患者和家属参与的有效性，并阐明将参与纳入多方面方法以改善患者安全终点的额外益处。此外，应研究评估和克服患者积极参与护理意愿障碍的策略。
