O'Hara Jane K, Lawton Rebecca J, Armitage Gerry, Sheard Laura, Marsh Claire, Cocks Kim, McEachan Rosie R C, Reynolds Caroline, Watt Ian, Wright John
Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, England. Jane.o'
Leeds Institute of Medical Education, University of Leeds, Level 7 Worsley Building, Clarendon Way, Leeds, LS2 9NL, England. Jane.o'
BMC Health Serv Res. 2016 Nov 28;16(1):676. doi: 10.1186/s12913-016-1919-z.
There is growing interest in the role of patients in improving patient safety. One such role is providing feedback on the safety of their care. Here we describe the development and feasibility testing of an intervention that collects patient feedback on patient safety, brings together staff to consider this feedback and to plan improvement strategies. We address two research questions: i) to explore the feasibility of the process of systematically collecting feedback from patients about the safety of care as part of the PRASE intervention; and, ii) to explore the feasibility and acceptability of the PRASE intervention for staff, and to understand more about how staff use the patient feedback for service improvement.
We conducted a feasibility study using a wait-list controlled design across six wards within an acute teaching hospital. Intervention wards were asked to participate in two cycles of the PRASE (Patient Reporting & Action for a Safe Environment) intervention across a six-month period. Participants were patients on participating wards. To explore the acceptability of the intervention for staff, observations of action planning meetings, interviews with a lead person for the intervention on each ward and recorded researcher reflections were analysed thematically and synthesised.
Recruitment of patients using computer tablets at their bedside was straightforward, with the majority of patients willing and able to provide feedback. Randomisation of the intervention was acceptable to staff, with no evidence of differential response rates between intervention and control groups. In general, ward staff were positive about the use of patient feedback for service improvement and were able to use the feedback as a basis for action planning, although engagement with the process was variable. Gathering a multidisciplinary team together for action planning was found to be challenging, and implementing action plans was sometimes hindered by the need to co-ordinate action across multiple services.
The PRASE intervention was found to be acceptable to staff and patients. However, before proceeding to a full cluster randomised controlled trial, the intervention requires adaptation to account for the difficulties in implementing action plans within three months, the need for a facilitator to support the action planning meetings, and the provision of training and senior management support for participating ward teams.
The PRASE intervention represents a promising method for the systematic collection of patient feedback about the safety of hospital care.
患者在提高患者安全方面所起的作用日益受到关注。其中一个作用是提供有关其护理安全性的反馈。在此，我们描述了一项干预措施的开发和可行性测试，该措施收集患者对患者安全的反馈，召集工作人员审议此反馈并制定改进策略。我们探讨两个研究问题：i）探索作为PRASE干预措施一部分，系统收集患者关于护理安全性反馈过程的可行性；ii）探索PRASE干预措施对工作人员的可行性和可接受性，并更多地了解工作人员如何利用患者反馈来改进服务。
我们在一家急性教学医院的六个病房采用等待列表对照设计进行了一项可行性研究。干预病房被要求在六个月内参与两个周期的PRASE（患者安全环境报告与行动）干预。参与者是参与病房中的患者。为了探索干预措施对工作人员的可接受性，对行动计划会议进行了观察，对每个病房的干预负责人进行了访谈，并对研究人员的记录反思进行了主题分析和综合。
在床边使用电脑平板电脑招募患者很顺利，大多数患者愿意并能够提供反馈。工作人员接受干预措施的随机分组方式，没有证据表明干预组和对照组之间的反应率存在差异。总体而言，病房工作人员对利用患者反馈来改进服务持积极态度，并能够将反馈作为行动计划的基础，尽管参与过程存在差异。发现召集多学科团队进行行动计划具有挑战性，并且实施行动计划有时会因需要协调多个服务部门的行动而受到阻碍。
发现PRASE干预措施对工作人员和患者都是可接受的。然而，在进行全面整群随机对照试验之前，该干预措施需要进行调整，以解决在三个月内实施行动计划的困难、需要一名促进者来支持行动计划会议，以及为参与病房团队提供培训和高级管理层支持等问题。
PRASE干预措施是系统收集患者关于医院护理安全性反馈的一种有前景的方法。
