From the Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary Duckworth Lane, Bradford, United Kingdom.
Queen's University, Kingston, Canada.
J Patient Saf. 2022 Dec 1;18(8):e1203-e1210. doi: 10.1097/PTS.0000000000001054. Epub 2022 Aug 2.
Investigations of healthcare harm often overlook the valuable insights of patients and families. Our review aimed to explore the perspectives of key stakeholders when patients and families were involved in serious incident investigations.
The authors searched three databases (Medline, PsycInfo, and CINAHL) and Connected Papers software for qualitative studies in which patients and families were involved in serious incident investigations until no new articles were found.
Twenty-seven papers were eligible. The perspectives of patients and families, healthcare professionals, nonclinical staff, and legal staff were sought across acute, mental health and maternity settings. Most patients and families valued being involved; however, it was important that investigations were flexible and sensitive to both clinical and emotional aspects of care to avoid compounding harm. This included the following: early active listening with empathy for trauma, sincere and timely apology, fostering trust and transparency, making realistic timelines clear, and establishing effective nonadversarial communication. Most staff perceived that patient and family involvement could improve investigation quality, promote an open culture, and help ensure future safety. However, it was made difficult when multidisciplinary input was absent, workload and staff turnover were high, training and support needs were unmet, and fears surrounded litigation. Potential solutions included enhancing the clarity of roles and responsibilities, adequately training staff, and providing long and short-term support to stakeholders.
Our review provides insights to ensure patient and family involvement in serious incident investigations considers both clinical and emotional aspects of care, is meaningful for all key stakeholders, and avoids compounding harm. However, significant gaps in the literature remain.
医疗伤害的调查往往忽略了患者和家属的宝贵意见。我们的综述旨在探讨当患者和家属参与严重事件调查时，主要利益相关者的观点。
作者在 Medline、PsycInfo 和 CINAHL 三个数据库以及 Connected Papers 软件中搜索了患者和家属参与严重事件调查的定性研究，直到没有新的文章出现。
有 27 篇论文符合条件。在急性、心理健康和产科环境中，寻求了患者和家属、医疗保健专业人员、非临床人员和法律人员的观点。大多数患者和家属都重视参与；然而，调查需要灵活且敏感地处理临床和情感方面的护理，以避免加重伤害。这包括以下几点：对创伤进行早期有同理心的积极倾听，真诚和及时的道歉，培养信任和透明度，明确现实的时间表，并建立有效的非对抗性沟通。大多数工作人员认为患者和家属的参与可以提高调查质量，促进开放文化，并有助于确保未来的安全。然而，当缺乏多学科的投入、工作量和员工流动率高、培训和支持需求未得到满足以及对诉讼的担忧时，这会变得很困难。潜在的解决方案包括明确角色和责任、充分培训员工以及为利益相关者提供长期和短期支持。
我们的综述提供了一些见解，以确保患者和家属参与严重事件调查既要考虑临床方面，也要考虑护理的情感方面，对所有主要利益相关者都有意义，并且避免加重伤害。然而，文献中仍存在重大差距。
