Care partner engagement in patient safety for adult inpatients at the direct care level in hospital: a qualitative systematic review

Objective: The objective of this qualitative systematic review was to understand the experiences of care partner engagement in patient safety at the direct care level from the perspectives of care partners, adult patients, and health care professionals. Introduction: Patient safety is a concern for health care organizations. Engaging care partners (eg, family members who can contribute by observing and acting to protect patients) is a strategy to enhance patient safety at the point of care. Understanding the qualitative evidence about care partner experiences in safety is crucial to improve engagement policies and enhance hospital safety strategies. Eligibility criteria: This systematic review included qualitative studies that describe experiences of care partner engagement in patient safety at the direct care level in hospitals from the perspectives of care partners, adult inpatients, and health care professionals who provide care in hospitals. The engagement of care partners in safety in pediatric hospitals was outside the scope of this review. Methods: This review followed the JBI methodology for systematic reviews of qualitative evidence, adhering to an a priori protocol. A 3-step search strategy was employed, including an initial literature search in MEDLINE and searches in 6 databases, with no restrictions on language or publication year. Two reviewers independently assessed the studies for inclusion and evaluated the papers’ methodological quality. Findings were extracted and considered for shared meaning and grouped into categories. In the meta-synthesis, common categories were grouped to produce the synthesized findings. The ConQual approach was used to determine the level of confidence in the synthesized findings. Results: Seventeen studies were included. Five synthesized findings were extracted from 16 categories and 76 findings: i) Effective communication with health care professionals ensures that care partners can share unique patient information and receive essential medical details that support safe care, enhance comfort, and are crucial during patient transfers; ii) Care partners can implement strategies to reduce risks and ensure safety during a patient’s hospital admission; iii) Health care professionals often have mixed feelings about involving care partners in patient safety and carefully consider how to address their concerns; iv) Engaging in patient safety is an emotional experience for care partners that is not always favorable, particularly when efforts to voice concerns to health care professionals are dismissed; and v) A care partner’s willingness and assertiveness to seek and maintain engagement in patient safety efforts is shaped by previous experience(s) with the health care system, self-determined medical knowledge, feelings about trust in the health care professionals, and self-assessed of risk of harm in the given context. Conclusions: Care partners’ willingness to engage in safety activities varies based on health professionals and past health system experiences. Limitations of the review include the lack of research about care partner experiences independent of patients. Recommendations include that care partner safety engagement programs should not place undue burden on care partners. Review registration: PROSPERO CRD42023476286