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Improving the governance of patient safety in emergency care: a systematic review of interventions

Improving the governance of patient safety in emergency care: a systematic review of interventions
Improving the governance of patient safety in emergency care: a systematic review of interventions
OBJECTIVES: To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility.

DESIGN: A systematic review of the literature.

METHODS: PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings.

RESULTS: Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively.

CONCLUSIONS: Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an experimental design with valid outcome measures to strengthen the evidence base.
1-13
Hesselink, Gijs
8c2e5d5b-d2bc-4534-8282-ab09496ede37
Berben, Sivera
69159618-3220-4de7-a59e-53776cfe022a
Beune, Thimpe
59db8c51-09f1-41dd-b02b-9a2f89167390
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de
Hesselink, Gijs
8c2e5d5b-d2bc-4534-8282-ab09496ede37
Berben, Sivera
69159618-3220-4de7-a59e-53776cfe022a
Beune, Thimpe
59db8c51-09f1-41dd-b02b-9a2f89167390
Schoonhoven, Lisette
46a2705b-c657-409b-b9da-329d5b1b02de

Hesselink, Gijs, Berben, Sivera, Beune, Thimpe and Schoonhoven, Lisette (2016) Improving the governance of patient safety in emergency care: a systematic review of interventions. BMJ Open, 6 (e009837), 1-13. (doi:10.1136/bmjopen-2015-009837). (PMID:26826151)

Record type: Article

Abstract

OBJECTIVES: To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility.

DESIGN: A systematic review of the literature.

METHODS: PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings.

RESULTS: Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively.

CONCLUSIONS: Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an experimental design with valid outcome measures to strengthen the evidence base.

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More information

Accepted/In Press date: 30 November 2015
Published date: 29 January 2016
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 388444
URI: http://eprints.soton.ac.uk/id/eprint/388444
PURE UUID: 2094d39f-d06d-45cd-850b-562931e622e9
ORCID for Lisette Schoonhoven: ORCID iD orcid.org/0000-0002-7129-3766

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Date deposited: 25 Feb 2016 16:29
Last modified: 15 Mar 2024 03:41

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Contributors

Author: Gijs Hesselink
Author: Sivera Berben
Author: Thimpe Beune

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