Hospital initiatives to involve patients and carers in recognizing clinical deterioration and escalating concerns: a scoping review including considerations for culturally and linguistically diverse populations.

objectiveThe objective of this review was to identify and describe what is reported on hospital initiatives to involve patients and carers in recognizing and escalating clinical deterioration concerns, including the considerations within these initiatives to involve people from culturally and linguistically diverse (CALD) backgrounds.

introductionEngaging patients and their carers in recognizing clinical deterioration and escalating concerns is increasingly accepted as a strategy to improve patient safety in hospitals. As initiatives to support this engagement have developed, the involvement of patients and carers from CALD backgrounds has not been comprehensively considered. An exploration of what has been reported in the literature to involve the CALD community is an important first step to inform ongoing research in this area of patient safety. ELIGIBILITY CRITERIA: Published and gray literature describing hospital initiatives to involve patients and carers in recognizing clinical deterioration and escalating concerns were considered.

methodsA scoping review of the literature was conducted following JBI methodological guidance and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). A 4-step search strategy explored evidence from databases and search engines, gray literature, and reference lists from 2005 until April 2024. The databases searched were MEDLINE (Ovid), CINAHL Ultimate (EBSCOhost), ProQuest Central, JBI Evidence-Based Practice Database (Ovid), and Informit. Google, Google Scholar, and ProQuest Dissertations and Theses were also searched, and we conducted a targeted search of related Australian and New Zealand government initiatives. After screening potential evidence sources, data were extracted, mapped, and analyzed using thematic analysis. Analyzed data were then presented in tables with an accompanying narrative summary, linking the results of the review to the objectives and questions.

resultsA total of 45 sources were selected for inclusion, including primary research, conference proceedings, and gray literature. The largest number of sources came from Australia and the United States, with an almost even spread of adult and pediatric settings. Nineteen initiatives to involve patients and carers in recognizing clinical deterioration and escalating concerns were identified and grouped into 5 types: i) escalation to the primary care team; ii) an activation process to summon help either from an independent rapid response team or a separate person or team to triage the level of response required; iii) patient and carer education; iv) a standardized communication bundle; and v) wellness or concern scoring measures. Initiatives were commonly supported by structured patient information delivery and followed a stepped approach involving escalation to the primary care team prior to activation of an independent response. A wide range of methods to evaluate effectiveness is used with no consensus on indicators to evaluate outcomes. Considerations found within initiatives to involve the CALD community include participation in patient- and carer-activated escalation initiative development, communication, and organizational cultural safety.

conclusionsHospital initiatives to involve patients and carers in recognizing clinical deterioration commonly incorporated clear escalation pathways and structured information, but evaluation was inconsistent and lacked standardized indicators. Limited consideration within initiatives was given to involving patients and carers from CALD backgrounds. Health care researchers should partner with CALD communities to conduct further research to understand their diverse needs. This understanding will inform future development of innovative strategies to ensure that these diverse needs are met and help improve health outcomes and quality of care. REVIEW REGISTRATION: OSF https://osf.io/rct6p/.