Wagner Jesse, Aboumatar Hanan, Treadwell Jonathan R.
To summarize recent relevant literature on patient safety practices (PSPs) focused on engaging family caregivers with structured communication during care transitions and assess the effectiveness of these PSPs to improve safety during care transitions. This review provides information for clinicians, health system leaders, and policymakers to better inform approaches to engaging family caregivers with structured communication to improve safety during care transitions.
We followed rapid review processes provided by the Agency for Healthcare Research and Quality Evidence-based Practice Center Program. We searched PubMed, Embase, and the Cochrane Library for eligible studies published in 2010 through June 30, 2023, supplemented by targeted gray literature searches and review of reference lists in relevant systematic reviews. We used prespecified inclusion and exclusion criteria to assess relevant studies conducted in the United States that analyzed the effect of structured communication on care transitions with family caregivers. Prespecified clinical and patient-related outcomes included healthcare utilization, symptom exacerbation, quality of life, satisfaction, and unintended harms, among others.
We identified 323 unique citations for possible inclusion; we assessed 86 full-text articles for inclusion. We included nine studies on effectiveness (2 randomized controlled trials, 6 pre-post studies, and 1 single-arm study) which assessed PSPs focused on discharge to home, transfers from intensive care units, and transitions from residential care. In residential treatment facility discharges, we found PSPs improved caregiver satisfaction (low strength of evidence [SOE]). We found insufficient evidence of other PSPs on any other included outcomes. Five studies detailed implementation facilitators, and two studies noted specific barriers to PSP implementation. While no studies specifically reported the resources required to implement PSPs, based on study descriptions, we identified four prominent resource considerations: (1) allocated time for pre-implementation intervention development and staff training; (2) designated time to deliver PSPs to family caregivers; (3) technology-based resources; (4) staff-expertise/addition training for designated roles. None of the studies reported rates of unintended harms.
Clear communication with patients and caregivers during care transitions is important, but there is little evidence on the effectiveness of these PSPs. Included studies showed improvement in caregiver satisfaction, but more high-quality research is needed to assess the effectiveness of PSPs and unintended harms.
总结近期有关患者安全实践（PSPs）的相关文献，这些实践聚焦于在护理转接期间让家庭照护者参与结构化沟通，并评估这些PSPs在改善护理转接期间安全性方面的有效性。本综述为临床医生、卫生系统领导者和政策制定者提供信息，以便更好地为让家庭照护者参与结构化沟通以改善护理转接期间安全性的方法提供依据。
我们遵循了医疗保健研究与质量机构循证实践中心计划提供的快速综述流程。我们在PubMed、Embase和Cochrane图书馆中搜索2010年至2023年6月30日发表的符合条件的研究，并辅以针对性的灰色文献搜索以及对相关系统评价中参考文献列表的审查。我们使用预先设定的纳入和排除标准来评估在美国进行的相关研究，这些研究分析了结构化沟通对与家庭照护者进行护理转接的影响。预先设定的临床和患者相关结局包括医疗保健利用、症状加重、生活质量、满意度和意外伤害等。
我们识别出323条可能纳入的独特引文；我们评估了86篇全文文章以确定是否纳入。我们纳入了9项关于有效性的研究（2项随机对照试验、6项前后对照研究和1项单臂研究），这些研究评估了聚焦于出院回家、从重症监护病房转出以及从住院护理机构转出的PSPs。在住院治疗机构出院方面，我们发现PSPs提高了照护者满意度（证据强度低）。我们发现没有足够证据表明其他PSPs对任何其他纳入的结局有影响。5项研究详细阐述了实施促进因素，2项研究指出了PSPs实施的具体障碍。虽然没有研究专门报告实施PSPs所需的资源，但根据研究描述，我们确定了四个突出的资源考量因素：（1）为实施前干预措施制定和员工培训分配时间；（2）为向家庭照护者提供PSPs指定时间；（3）基于技术的资源；（4）为指定角色提供员工专业知识/额外培训。没有研究报告意外伤害发生率。
在护理转接期间与患者和照护者进行清晰沟通很重要，但几乎没有证据表明这些PSPs的有效性。纳入的研究显示照护者满意度有所提高，但需要更多高质量研究来评估PSPs的有效性和意外伤害情况。
