BMJ Qual Saf doi:10.1136/bmjqs-2012-001769
  • Original research

Promoting engagement by patients and families to reduce adverse events in acute care settings: a systematic review

  1. Sydney M Dy4
  1. 1Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
  3. 3Division of General Medicine, Geriatrics, and Palliative Care, University of Virginia School of Medicine, Charlottesville, Virginia, USA
  4. 4Department of Health Policy and Management, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA
  5. 5Division of General Medicine, University of Michigan Health System, Center for Clinical Management Research, Ann Arbor VA Medical Center, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Zackary D Berger, Division of General Internal Medicine, Department of Medicine, The Johns Hopkins Outpatient Center, 601 North Caroline Street, Suite 7143, Baltimore, MD 21287-0941, USA; zberger1{at}
  • Received 18 December 2012
  • Revised 18 November 2013
  • Accepted 22 November 2013
  • Published Online First 13 December 2013


Introduction 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.

Objectives 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.

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