Institute of Global Health Innovation, Imperial College London, London, UK.
NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK.
J Glob Health. 2022 Feb 26;12:04018. doi: 10.7189/jogh.12.04018. eCollection 2022.
The number of people living in fragile, conflict-affected, and vulnerable (FCV) settings is growing rapidly and attention to achieving universal health coverage must be accompanied by sufficient focus on the safety of care for universal access to be meaningful. Healthcare workers in these settings are working under extreme conditions, often with insufficient contextualized evidence to support decision-making. Recognising the relative paucity of, and methodological issues in gathering evidence from these settings, the evidence scanning described in this paper considered which patient safety interventions might offer the 'better bet', eg, the most effective and appropriate intervention in FCV settings.
An evidence scanning approach was used to examine the literature. The search was limited to FCV settings and low-income settings as defined by the World Bank, but if a systematic review included a mix of evidence from FCV/low income settings, as well as low-middle income settings, it was included. The search was conducted in English and limited to studies published from 2003 onwards, utilising Google Scholar as a publicly accessible database and further review of the grey literature, with specific attention to the outputs of non-governmental organisations. The search and subsequent analysis were completed between April and June 2020.
The majority of studies identified related to strengthening infection prevention and control which was also found to be the 'better bet' intervention that could generalise to other settings, be most feasible to implement, and most effective for improving patient care and associated outcomes. Other prioritized interventions include risk management, with contributing elements such as reporting, audits, and death review processes.
Infection prevention and control interventions dominate in the literature for multiple reasons including strength of evidence, acceptability, feasibility, and impact on patient and health worker well-being. However, there is an urgent need to further develop the evidence base, specialist knowledge, and field guidance on a range of other patient safety interventions such as education and training, patient identification, subject specific safety actions, and risk management.
生活在脆弱、受冲突影响和易受伤害（FCV）环境中的人数正在迅速增加，在关注实现全民健康覆盖的同时，必须充分关注护理安全，以便全民获得有意义的医疗服务。在这些环境中工作的医疗保健工作者在极端条件下工作，往往缺乏充分的背景化证据来支持决策。鉴于从这些环境中收集证据的相对缺乏和方法问题，本文所述的证据扫描考虑了哪些患者安全干预措施可能提供“更好的选择”，例如在 FCV 环境中最有效和最合适的干预措施。
采用证据扫描方法来审查文献。搜索仅限于 FCV 环境和世界银行定义的低收入环境，但如果系统评价包括来自 FCV/低收入环境以及中低收入环境的混合证据，则包括在内。搜索仅以英语进行，并限于 2003 年以后发表的研究，利用 Google Scholar 作为公共可访问数据库，并进一步审查灰色文献，特别关注非政府组织的产出。搜索和随后的分析在 2020 年 4 月至 6 月之间进行。
确定的大多数研究都与加强感染预防和控制有关，这也是被发现的“更好的选择”干预措施，它可以推广到其他环境，实施起来最可行，并且对改善患者护理和相关结果最有效。其他优先干预措施包括风险管理，其组成要素包括报告、审计和死亡审查流程。
感染预防和控制干预措施在文献中占主导地位，原因包括证据强度、可接受性、可行性以及对患者和卫生工作者福祉的影响。然而，迫切需要进一步发展一系列其他患者安全干预措施的证据基础、专业知识和现场指导，例如教育和培训、患者识别、特定主题的安全措施和风险管理。
