title: Promoting engagement by patients and families to reduce adverse events in acute care settings: a systematic review.
abstract: BACKGROUND
  Patient-centeredness is central to healthcare. Hospitals should address patients' unique needs to improve safety and quality. Patient engagement in healthcare, which may help prevent adverse events, can be approached as an independent patient safety practice (PSP) or as part of a multifactorial PSP.
  
  
  OBJECTIVE
  This review examines how interventions encouraging this engagement have been implemented in controlled trials.
  
  
  METHODS
  We searched Medline, CINAHL, Embase and Cochrane from 2000 to 2012 for English language studies in hospital settings with prospective controlled designs, addressing the effectiveness or implementation of patient/family engagement in PSPs. We separately reviewed interventions implemented as part of selected broader PSPs by way of example: hand hygiene, ventilator-associated pneumonia, rapid response systems and care transitions.
  
  
  RESULTS
  Six articles met the inclusion criteria for effectiveness with a primary focus on patient engagement. We identified 12 studies implementing patient engagement as an aspect of selected broader PSPs. A number of studies relied on patients' possible function as a reporter of error to healthcare workers and patients as a source of reminders regarding safety behaviours, while others relied on direct activation of patients or families. Definitions of patient and family engagement were lacking, as well as evidence regarding the types of patients who might feel comfortable engaging with providers, and in what contexts.
  
  
  CONCLUSIONS
  While patient engagement in safety is appealing, there is insufficient high-quality evidence informing real-world implementation. Further work should evaluate the effectiveness of interventions on patient and family engagement and clarify the added benefit of incorporating engagement in multifaceted approaches to improve patient safety endpoints. In addition, strategies to assess and overcome barriers to patients' willingness to actively engage in their care should be investigated.
authors: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA.
authors: Zackary
authors: Z
authors: Berger
authors: Division of General Medicine, Geriatrics, and Palliative Care, University of Virginia School of Medicine, Charlottesville, Virginia, USA.
authors: Tabor E
authors: TE
authors: Flickinger
authors: Department of Health Policy and Management, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.
authors: Elizabeth
authors: E
authors: Pfoh
authors: Department of Health Policy and Management, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA Division of General Medicine, University of Michigan Health System, Center for Clinical Management Research, Ann Arbor VA Medical Center, Ann Arbor, Michigan, USA.
authors: Kathryn A
authors: KA
authors: Martinez
authors: Department of Health Policy and Management, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.
authors: Sydney M
authors: SM
authors: Dy
mesh_terms: D003140:Communicable Disease Control / Q000379:methods*; D006235:Hand Disinfection; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control; D061214:Patient Safety; D018802:Patient-Centered Care; D011368:Professional-Family Relations; D011369:Professional-Patient Relations
keywords: Hospital Medicine; Patient Education; Patient safety; Patient-Centred Care; Quality Improvement Methodologies