Top 2018 articles on patient and family engagement

Throughout 2018, papers on patient and family engagement in quality and safety were high-impact. In this post, we discuss four papers that illustrate some potential benefits and some of the challenges too.

In this cluster-randomised trial, O’Hara et al. show that patient-reported events can signal safety issues in relative real-time. The authors received directly-reported patient feedback for 14 categories of potential safety events from 579 inpatients in five hospitals. Of the 1155 patient-reported incidents, 35% were also classified by clinicians as patient safety incidents (PSIs) according to standard definitions – but, intriguingly, some might not have been identified using traditional safety event capture mechanisms. Of note, 90% of these identified incidents were rated as ‘probably or definitely avoidable’. Categories less frequently characterized as PSIs may be of importance in portending other safety or quality events:  they included communication concerns, care for the ward environment, and issues related to being treated with compassion or dignity and respect. This paper further adds to the evidence about patients themselves as an important source of intelligence about the safety of health systems.

Aggregating patient feedback comment and rating data from three sources – NHS Choices, Twitter, and Facebook – to form a near-time composite score, Griffiths and Leaver sought to determine whether a relationship could be established between the score and the outcomes of regulatory inspection. The study found that the better the patient feedback score over 90 days prior to an inspection, the greater the likelihood of the hospital or trust receiving an overall positive rating. All organisations judged “outstanding” by inspectors had an above average rating in patient feedback, leading the authors to suggest that patients may be better collective judges of when organisations are performing well rather than when they are performing poorly.

Patients may not feel empowered to voice concerns in many clinical encounters. Using surveys, Bell et al. studied families with members currently admitted to an intensive care unit and a national sample of families with members admitted to an ICU within the past 10 years. Across the situations presented, 50-70% of family members of currently admitted patients expressed hesitancy about voicing concerns in cases with known safety implications, such as mismatched care goals or inadequate hand hygiene. Approximately one-half of each group was able to provide at least one reason to be hesitant in speaking up to an ICU team: among other things, they did not want to be labeled a ‘troublemaker’, they perceived that the clinical team was too busy, and they had concerns about harming relationships with the care teams. These findings offer important indications of where improvements should be targeted.

  • Patient experience of general practice and use of emergency hospital services in England: regression analysis of national cross-sectional time series data – in print, August 2018. https://qualitysafety.bmj.com/content/27/8/643

One important hypothesis is that improving patient experience, including access, in primary care may reduce demand for other parts of the system – such as emergency departments (ED). Reviewing 98% of NHS general practices across three years, Cowling et al. studied whether three patient experience measures on the General Practice Patient Survey in England were associated with frequencies of emergency department (ED) visits and hospital admissions. Most survey respondents reported favourable experiences in their primary care general practices. Although rates of both ED visits and admissions increased across their study period, the adjusted regression analysis showed that a one SD increase in the experience of making an appointment in general practice was associated with only small decreases (1.8%) in ED visits and 1.4% in hospital admission rates. Satisfaction with opening hours and overall patient experience were not associated with either measure. Overall, the message appears to be that efforts to improve patient experience, including access, in primary care may not lead to substantial reductions in other forms of healthcare utilization.

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