Adverse event reviews in healthcare: what matters to patients and their family? A qualitative study exploring the perspective of patients and family.

OBJECTIVES: Explore what 'good' patient and family involvement in healthcare adverse event reviews may involve. DESIGN: Data was collected using semi-structured telephone interviews. Interview transcripts were analysed using an inductive thematic approach. SETTING: NHS Scotland. PARTICIPANTS: 19 interviews were conducted with patients who had experienced an adverse event during the provision of their healthcare or their family member. RESULTS: Four key themes were derived from these interviews: trauma, communication, learning and litigation. CONCLUSIONS: There are many advantages of actively involving patients and their families in adverse event reviews. An open, collaborative, person-centred approach which listens to, and involves, patients and their families is perceived to lead to improved outcomes. For the patient and their family, it can help with reconciliation following a traumatic event and help restore their faith in the healthcare system. For the health service, listening and involving people will likely enhance learning with subsequent improvements in healthcare provision with reduction in risk of similar events occurring for other patients. This study suggests eight recommendations for involving patients and families in adverse event reviews using the APICCTHS model (table 3) which includes an apology, person-centred inclusive communication, closing the loop, timeliness, putting patients and families at the heart of the review with appropriate support for staff involved. Communicating in a compassionate manner could also decrease litigation claims following an adverse event.

Factors associated with alcohol reduction in harmful and hazardous drinkers following alcohol brief intervention in Scotland: a qualitative enquiry.

BACKGROUND: Alcohol Brief Intervention (ABI) uses a motivational counselling approach to support individuals to reduce excessive alcohol consumption. There is growing evidence on ABI's use within various health care settings, although how they work and which components enhance success is largely unknown. This paper reports on the qualitative part of a mixed methods study. It explores enablers and barriers associated with alcohol reduction following an ABI. It focuses on alcohol's place within participants' lives and their personal perspectives on reducing consumption. There are a number of randomised controlled trials in this field though few ABI studies have addressed the experiences of hazardous/harmful drinkers. This study examines factors associated with alcohol reduction in harmful/hazardous drinkers following ABI. METHODS: This qualitative study was underpinned by a realist evaluation approach and involved semi-structured interviews with ten harmful or hazardous alcohol drinkers. Participants (n = 10) were from the intervention arm of a randomised controlled trial (n = 124). All had received ABI, a 20 min motivational counselling interview, six months previously, and had reduced their alcohol consumption. Interviews were recorded, transcribed verbatim and thematically analysed. RESULTS: Participants described their views on alcohol, its' place in their lives, their personal perspectives on reducing their consumption and future aspirations. CONCLUSIONS: The findings provide an insight into participants' views on alcohol, ABI, and the barriers and enablers to change. Participants described a cost benefit analysis, with some conscious consideration of the advantages and disadvantages of reducing intake or abstaining from alcohol. Findings suggest that, whilst hospital admission can act as a catalyst, encouraging individuals to reflect on their alcohol consumption through ABI may consolidate this, turning this reflective moment into action. Sustainability may be enhanced by the presence of a 'significant other' who encourages and experiences benefit. In addition having a purpose or structure with activities linked to employment and/or social and leisure pursuits offers the potential to enhance and sustain reduced alcohol consumption. TRIAL REGISTRATION: Trial registration number TRN NCT00982306 September 22nd 2009.

Effectiveness of Alcohol Brief Intervention in a General Hospital: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to examine the effectiveness of an alcohol brief intervention (ABI) on alcohol consumption in hazardous or harmful drinkers compared with screening alone within a general hospital setting. METHOD: Following screening, 124 hazardous or harmful drinkers (103 men, ages 18-80 years, score of 3-12 on the Fast Alcohol Screening Test [FAST]) admitted to medical and orthopedic wards during the 13-month recruitment period were randomized to receive an ABI or control. The intervention group received an ABI where they were supported to set their own personalized alcohol reduction goals, and both groups received a health information leaflet. Retrospective alcohol consumption for 7 days was reported for the week, before hospital admission and 6 months after it. RESULTS: Demographics and clinical characteristics at baseline showed no statistical differences between the two groups on all variables except FAST score, which was higher in the intervention group (p ≤ .05). A reduction of 85 grams of alcohol per week (95% CI [162.46, 7.54]) was observed between groups in favor of the intervention group based on changes from baseline. However, there was no significant difference between groups for absolute grams of alcohol per week at 6 months. A significant mean difference in favor of the intervention group (U = 1,537, p = .043) was observed for weekly heavy drinking episodes. CONCLUSIONS: Our results suggest screening with delivery of ABI for harmful/hazardous drinkers in a general hospital is beneficial in reducing alcohol consumption compared with screening alone.