Approaches to improving patient safety in integrated care: a scoping review

Abstract

ObjectivesThis scoping review aimed to establish the approaches employed to improving patient safety in integrated care for community-dwelling adults with long-term conditions.DesignScoping review.SettingAll care settings.Search strategySystematic searches of seven academic and grey literature databases for studies published between 2000 and 2021. At the full-text review stage both the first and second reviewer (SW) independently assessed full texts against the eligibility criteria and any discrepancies were discussed.ResultsOverall, 24 studies were included in the review. Two key priorities for safety across care boundaries for adults with long-term conditions were falls and medication safety. Approaches for these priorities were implemented at different levels of an integrated care system. At the micro-level, approaches involved care primarily in the home setting provided by multi-disciplinary teams. At the meso-level, the focus was on planning and designing approaches at the managerial/organisational level to deliver multi-disciplinary care. At the macro-level, system-wide approaches included integrated care records, training and education and the development of care pathways involving multiple organisations. Across the included studies, evaluation of these approaches was undertaken using a wide range of process and outcome measures to capture patient harm and contributory factors associated with falls and medication safety.ConclusionsFor integrated care initiatives to fulfil their promise of improving care for adults with long-term conditions, approaches to improve patient safety need to be instituted across the system, at all levels to support the structural and relational aspects of integrated care as well as specific risk-related safety improvements.

Media presentation of hospital discharge to care homes during the COVID-19 pandemic

“…Furthermore, it has long been established that care is fragmented across health and social care services, which has been described as a "wicked problem" (Shaw and Rosen, 2013)a problem defined by its complex interactions between multiple people and organisations in disagreement without an obvious solution, but where a desired change is recognised (Rittel and Webber, 1974) when spanning organisational and sectoral boundaries. Improving the quality and safety of integrated care in part relies upon relational aspects of care between professionals (Lalani et al, 2023) and person-centred care with service users (Davidson et al, 2021), yet media framing of narratives surrounding care homes during the pandemic may further marginalise care home staff and thus influence these relational aspects of care, as well as minimising potential moral injury amongst care home staff that has been identified during the COVID-19 pandemic (Gaitens et al, 2021). The focus on morality as a defining outcome, particularly moral outcomes, generates implications for health and social care sectors, including the integration of care.…”

Development of a Hospital-Stakeholder Collaboration Tool Using Mixed Methods to Assess Stakeholder Perspectives for Hospital Service Improvement

“…Then those domains were used to form the hypothesis and questionnaire, which were tested quantitatively ( 21 ). The five tools are HSC ( 1 ) for the patient ( 2 ) for the patient's family, ( 3 ) for internal doctors, ( 4 ) for external doctors, and ( 5 ) health insurance company. Methodological development was conducted in three steps ( Fig 1 ): ( 1 ) initial tool development; ( 2 ) validity testing and item adjustment; and ( 3 ) module development.…”

“…The five tools are HSC ( 1 ) for the patient ( 2 ) for the patient's family, ( 3 ) for internal doctors, ( 4 ) for external doctors, and ( 5 ) health insurance company. Methodological development was conducted in three steps ( Fig 1 ): ( 1 ) initial tool development; ( 2 ) validity testing and item adjustment; and ( 3 ) module development. Several research methods were employed, including literature reviews, primary qualitative and quantitative research, item consolidation with experts, and peer review by key stakeholders, as described in the following sections ( 22 ).…”

“…This study focused on service improvement, which is another side of quality improvement. The quality improvement focused on the clinical processes, and the service improvement focused on the non-clinical aspects, which led to a more satisfying and patient-centered experience ( 1 – 3 ). The future of the hospital proposed by Filho contains a pillar of patient-centered care.…”