Patient and family engagement has become a central theme in patient safety policy and improvement. Patients and relatives may observe care across time, professional boundaries and transitions, and may therefore identify safety concerns, errors, omissions or deterioration that are not always visible to professionals or captured in formal reporting systems. However, the role of patients and families as an additional safety barrier is inconsistently defined. It includes educational activation, speaking up, reminders about safe practices, verification of identity or medication, patient-reported safety concerns, family escalation systems, involvement in rounds, use of patient portals or tablets, and participation in learning from adverse events. Evidence is heterogeneous and includes reviews, trials, qualitative studies, surveys, vignette studies, feasibility studies and institutional reports. A scoping review is therefore appropriate to map the field, clarify concepts and identify implementation and ethical conditions. Berger et al. (2014) provides the most relevant baseline. It reviewed controlled evidence in acute care settings up to 2012, distinguishing patient/family engagement as an independent patient safety practice from engagement embedded within broader practices such as hand hygiene, ventilator-associated pneumonia prevention, rapid response systems and care transitions. Its findings were limited: six primary engagement studies and 12 studies where engagement formed part of a broader patient safety practice. It also highlighted three gaps that justify the present scoping review: inconsistent definitions, limited evidence on implementation in real-world settings, and insufficient knowledge about which patients or family members feel able to engage, with whom and under what conditions. Accordingly, this registered scoping review is defined as a post-Berger review. The main eligibility period starts in 2015; 2014 will be searched only as a bridge year to capture records published around Berger et al. or already in preparation. This review will map how patients and families are positioned as a safety barrier through specific mechanisms: preventing, detecting, interrupting, checking, verifying, reporting, escalating, alerting, feeding back, or mitigating safety incidents and adverse events. The review also includes implementation conditions, professional response, acceptability, barriers, facilitators and ethical concerns, particularly the risk of shifting responsibility for safety from healthcare organizations to patients and families. Review questions 1. What evidence exists on the role of patients and family members as an additional safety barrier for preventing, detecting, reporting, interrupting, escalating or mitigating adverse events and patient safety incidents? 2. What types of interventions, tools or practices have been used to activate or support this role? 3. In which clinical settings, populations and safety domains has this role been studied? 4. What mechanisms are proposed to explain how patient/family involvement may improve safety? 5. What outcomes have been measured, and what are the main reported findings? 6. What barriers, facilitators, implementation conditions and ethical concerns are described?
Mira et al. (Thu,) studied this question.