Engaging patients and families in communication across transitions of care: an integrative review

Quality and Patient Safety

Effective engagement and good communication with patients and their families and support people are key to ensuring safe transitions in care.

Challenge

Transitions of care are vulnerable times for patients. Adverse events such as drug administration issues, falls, missed diagnoses, hospital related infection and delirium are more likely to occur during transition periods. Practices that promote effective transitions in care are variable, and structural support within services for engaging in this way are needed.

Solution

Effective engagement and good communication with patients and their families/support people are key to ensuring safe transitions in care. Structured engagement that considers timing, privacy and location and appropriateness for patients and families is paramount and organisational strategies to improve communication must centre on patient needs. To encourage successful healthcare discussions, communication training should be offered to patients, families, and health professionals to improve quality of care.

Impact

The findings of the review are intended to inform recommendations for the development of structures, processes and resources to enhance communication between patients, families and health professionals during transitions of care, reduce adverse patient outcomes during these times and enhance quality of care.

Partners

Deakin University School of Nursing and Midwifery

With an increased focus on person-centred care in the past decade, there has been a heightened awareness of the role of the consumer and health care professionals in the communication and delivery of health care, making a review of the literature timely. By increasing understanding of how to improve engagement with patients and families during transitions of care, health professionals could optimise their approaches to support patient safety.

Studies have demonstrated that patient and family participation in health care, in partnership with health professionals, can have a positive influence on patient outcomes [1,2], satisfaction with care [3], the prevalence of adverse events [4] and the reduction of readmission rates [5–8].

Recognition of the value of patient-centred care (PCC) has motivated international efforts to reform health services to become more patient-centred [9,10] through improved communication between health professionals, patients and families.

This study, led by Alfred Deakin Professor Tracey Bucknall and researchers from the Institute’s Centre for Quality and Patient Safety Research (QPS), aimed to determine the current evidence about patient and family engagement in communication with health professionals during transitions of care to, within, and from acute care settings.

The researchers conducted an integrative review including studies from 2003-2017, analysing and synthesising 40 eligible studies to explain current evidence and gaps in knowledge about patient and family engagement in communication during transitions of care. The settings for the majority of evidence were acute hospitals or from hospitals to external services. Evidence was mostly descriptive and explorative, with a major gap identified in evidence of effectiveness of interventions to improve communication. In synthesising the evidence, four themes were evident: partnering in care; augmenting communication at transitions; impeding information exchange; and outcomes of communication at transitions.

This review was the first to comprehensively synthesise the literature about patient and family engagement in transition communication in acute care, and highlighted the increasing number of initiatives to improve communication. However, less is known about supporting families to engage in transition communication, and further research is required into the roles and contributions of nursing and non-nursing members of multidisciplinary teams. The review highlighted several organisational strategies to address the deficits in the system, yet evidence of effectiveness is clearly lacking.

The findings of this review can serve as a basis for designing new policies and practices, and their evaluation to further inform understanding of what works and what needs further development.

1: J.H. Hibbard and J. Greene Health Aff., 32 (2) (2013), pp. 207-214 What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs

2: F. Légaré, S. Turcotte, D. Stacey, S. Ratté, J. Kryworuchko and I.D. Graham The Patient – Patient-Centered Outcomes Research, 5 (1) (2012), pp. 1-19 Patients’ perceptions of sharing in decisions

3: C. Weingart, T. Herstich, P. Baker, M.L. Garrett, M. Bird, J. Billock, H.P. Schwartz and M.T. Bigham Air Med. J., 32 (1) (2013), pp. 40-46 Making good better: implementing a standardized handoff in pediatric transport

4: S.N. Weingart, J. Zhu, L. Chiappetta, S.O. Stuver, E.C. Schneider, A.M. Epstein, J.A. David-Kasdan, C.L. Annas, F.J.J. Fowler and J.S. Weissman Int. J. Qual. Health Care, 23 (3) (2011), pp. 269-277 Hospitalized patients’ participation and its impact on quality of care and patient safety
 
5: S. McClintock, R. Mose and L.F. Smith J. Nurse Pract., 10 (6) (2014), pp. 430-433 Strategies for reducing the hospital readmission rates of heart failure patients
 

6: E.A. Coleman, J.D. Smith, J.C. Frank, S.J. Min, C. Parry and A.M. Kramer J. Am. Geriatr. Soc., 52 (11) (2004), pp. 1817-1825 Preparing patients and caregivers to participate in care delivered across settings: the care transitions intervention

7: E.A. Coleman, C. Parry, S. Chalmers and S.-J. Min Arch. Intern. Med., 166 (17) (2006), pp. 1822-1828 The care transitions intervention: results of a randomized controlled trial
 
8: National Health and Hospitals Reform Commission Australian Government, Canberra (2009) A Healthier Future for All Australians – Final Report
 
9: Australian Commission on Safety and Quality in Health Care Australian Commission on Safety and Quality in Health Care, Sydney (2011) Patient-centred Care: Improving Quality and Safety Through Partnerships With Patients and Consumers
 
10: World Health Organisation (WHO) WHO, Geneva (2007) Patients for Patient Safety