Care partner engagement in patient safety at the direct care level in hospital: a qualitative systematic review protocol.

OBJECTIVE: The objective of this systematic review is to understand the experiences of care partner engagement in patient safety at the direct care level from the perspective of care partners, patients, and health care professionals. INTRODUCTION: Care partner engagement is a strategy for promoting patient safety in hospitals at the direct care level (ie, at the point where patient care is delivered). When present, care partners can increase safety by watching, listening, and taking action to protect admitted patients. To improve care partner presence policies and safety engagement strategies within hospitals, a comprehensive understanding of the current qualitative evidence about the breadth of experiences of care partner engagement in patient safety is required. INCLUSION CRITERIA: This review will include qualitative studies that consider the experiences of care partners, adult patients, and health care professionals. The engagement of care partners in patient safety within pediatric hospital settings will not be considered. METHODS: This review will follow the JBI methodology for systematic reviews of qualitative evidence. A preliminary literature search was conducted in MEDLINE and a full search strategy was developed for MEDLINE, Embase, CINAHL, and PsycINFO (all via Ovid), as well as the Cochrane Database of Systematic Reviews and JBI Evidence Synthesis. The JBI approach to study selection, critical appraisal, data extraction, data synthesis, and assessment of confidence will be followed. Two reviewers will test the screening criteria and data extraction protocol. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42023476286.

The revised JBI critical appraisal tool for the assessment of risk of bias for cohort studies.

Cohort studies are a robust analytical observational study design that explore the difference between two different cohorts on an outcome, differentiated by their exposure status. Despite being observational in nature, they are often included in systematic reviews of effectiveness, particularly when randomized controlled trials are limited or not feasible. Like all studies included in a systematic review, cohort studies must undergo a critical appraisal process to assess the extent to which a study has considered potential bias in its design, conduct, or analysis. Critical appraisal tools facilitate this evaluation. This paper introduces the revised critical appraisal tool for cohort studies, completed by the JBI Effectiveness Methodology Group (EMG), who are currently revising the suite of JBI critical appraisal tools for quantitative study designs. The revised tool responds to updates in methodological guidance from the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group and reporting guidance from PRISMA 2020, providing a robust framework for evaluating risk of bias in a cohort study. Transparent and rigorous assessment using this tool will assist reviewers in understanding the validity and relevance of the results and conclusions drawn from a systematic review that includes cohort studies. This may contribute to better evidence-based decision-making in health care. This paper discusses the key changes made to the tool, justifications for these changes, and provides practical guidance on how this tool should be interpreted and applied by systematic reviewers.

Implementing Triage-Bot: Supporting the Current Practice for Triage Nurses.

In Canada, emergency departments (ED) have 15.1 million unscheduled visits every year; this has been suggested to indicate that patients rely on ED to address the gaps experienced by 6.5 million Canadians who lack a primary care provider. When this large number of visits is coupled with a predicted shortage of 100,000 nurses in Canada by 2030, ED can be expected to face resource limitations, which highlights the importance of triage systems as a source of immediate support. Technology that incorporates innovative analytical methods, automation of routine, and efficient processing can be leveraged to enhance patient outcomes, streamline clinical processes, and improve the overall quality and efficiency of healthcare delivery. This paper aims to highlight how the Triage-Bot, a proposed AI system, can assist ED nurses when triaging patients. The Triage-Bot system is based on the Canadian Triage and Acuity Scale (CTAS), which currently serves as a standardized and highly effective tool for prioritizing patient care in emergency departments across the country. Pre-set and open-ended questions are asked using voice and video, allowing patients to describe their health concerns and conditions. Triage-Bot automatically measures the following vital signs: heart rate (HR), heart rate variability (HRV), oxygen saturation (SpO2), respiratory rate (RR), blood pressure (BP), blood glucose (BG), and stress. The system uses artificial intelligence models, particularly those with a deep learning approach that simultaneously analyzes both the user's facial expression and voice tone. Implementation: A systematic review addressed the implications of AI in nursing and concluded that it could contribute to patient care by providing personalized instructions and/or remotely monitoring patients. The Triage-Bot system can be implemented in healthcare facilities, such as emergency department waiting rooms. The information it collects can then be added to a patient's health records to support nurses in assessing the severity of each patient's condition. Limitations: If the system is accessed without a nurse's guidance, it is imperative that the user receives information regarding when to visit a healthcare provider or ED. Continuous improvements in Triage-Bot's accessibility for patients with varying abilities are required to ensure that the system remains user-friendly during times of illness. The voice and text interaction can also be influenced by a user's understanding of language, culture, and age-related factors.

Leaders' Role in Fostering a Just Culture.

Just culture supports learning, encourages transparency and minimizes harm following reported patient safety incidents. Healthcare leaders have a key role in establishing and maintaining a just culture to improve patient safety at the macro, meso and micro levels of the healthcare system. In this paper, we discuss the role of leaders at various levels in the healthcare system in fostering a just culture to support the reporting of and learning from patient safety incidents. Specifically, leadership challenges related to establishing a just culture to improve patient safety are analyzed. In addition, we identify opportunities for healthcare leaders to foster a just culture.

Supporting Quality Integrated Care for Adolescent Depression in Primary Care: A Learning System Approach.

Background: Quality integrated care, which involves primary care and mental health clinicians working together, can help identify and treat adolescent depression early. We explored systemic barriers to quality integrated care at the provincial level in Ontario, Canada using a learning system approach. Methods: Two Ontario Health Teams (OHTs), regional networks designed to support integrated care, completed the Practice Integration Profile (PIP) and participated in focus groups. Results: The OHTs had a median PIP score of 69 out of 100. Among the PIP domains, the lowest median score was case identification (50), and the highest one was workspace (100). The focus groups generated 180 statements mapped to the PIP domains. Workflow had the highest number of coded statements (59, 32.8%). Discussion: While the primary care practices included mental health clinicians on-site, the findings highlighted systemic barriers with adhering to the integrated care pathway for adolescent depression. These include limited access to mental health expertise for assessment and diagnosis, long wait times for treatment, and shortages of clinicians trained in evidence-based behavioral therapies. These challenges contributed to the reliance on antidepressants as the first line of treatment due to their accessibility rather than evidence-based guidelines. Conclusion: Primary care practices, within regional networks such as OHTs, can form learning systems to continuously identify the strategies needed to support quality integrated care for adolescent depression based on real-world data.

Common tool structures and approaches to risk of bias assessment: implications for systematic reviewers.

There are numerous tools available to assess the risk of bias in individual studies in a systematic review. These tools have different structures, including scales and checklists, which may or may not separate their items by domains. There are also various approaches and guides for the process, scoring, and interpretation of risk of bias assessments, such as value judgments, quality scores, and relative ranks. The objective of this commentary, which is part of the JBI Series on Risk of Bias, is to discuss some of the distinctions among different tool structures and approaches to risk of bias assessment and the implications of these approaches for systematic reviewers.

The revised JBI critical appraisal tool for the assessment of risk of bias for quasi-experimental studies.

Systematic reviews of effectiveness offer a rigorous synthesis of the best evidence available regarding the effects of interventions or treatments. Randomized controlled trials are considered the optimal study design for evaluating the effectiveness of interventions and are the ideal study design for inclusion in a systematic review of effectiveness. In the absence of randomized controlled trials, quasi-experimental studies may be relied on to provide information on treatment or intervention effectiveness. However, such studies are subject to unique considerations regarding their internal validity and, consequently, the assessment of the risk of bias of these studies needs to consider these features of design and conduct. The JBI Effectiveness Methodology Group has recently commenced updating the suite of JBI critical appraisal tools for quantitative study designs to align with the latest advancements in risk of bias assessment. This paper presents the revised critical appraisal tool for risk of bias assessment of quasi-experimental studies; offers practical guidance for its use; provides examples for interpreting the results of risk of bias assessment; and discusses major changes from the previous version, along with the justifications for those changes.

Investigating the impact of the COVID-19 pandemic on the occurrence of medication incidents in Canadian community pharmacies.

As the COVID-19 pandemic unfolded, community pharmacies adapted rapidly to broaden and adjust the services they were providing to patients, while coping with severe pressure on supply chains and constrained social interactions. This study investigates whether these events had an impact on the medication incidents reported by pharmacists. Results indicate that Canadian pharmacies were able to sustain such stress while maintaining comparable safety levels. At the same time, it appears that some risk factors that were either ignored or not meaningful in the past started to be reported, suggesting that community pharmacists are now aware of a larger set of contributing factors that can lead to medication incidents, notably for medication incidents that can lead to harm.

The benefits and opportunities: Engaging patients in identifying and reporting patient safety incidents.

There is growing recognition that patients can and should be engaged in the identification of patient safety incidents arising during their experiences across health systems. In this article, we describe the benefits that can be harnessed from engaging patients in reporting patient safety incidents; identify opportunities to support patient engagement in reporting and learning from patient safety incidents; and describe the potential role of health leaders in connecting patient experience and patient safety using patient-reported patient safety incident data.

From critical appraisal to risk of bias assessment: clarifying the terminology for study evaluation in JBI systematic reviews.

The foundations for critical appraisal of literature have largely progressed through the development of epidemiologic research methods and the use of research to inform medical teaching and practice. This practical application of research is referred to as evidence-based medicine and has delivered a standard for the health care profession where clinicians are equally as engaged in conducting scientific research as they are in the practice of delivering treatments. Evidence-based medicine, now referred to as evidence-based health care, has generally been operationalized through empirically supported treatments, whereby the choice of treatments is substantiated by scientific support, usually by means of an evidence synthesis. As evidence synthesis methodology has advanced, guidance for the critical appraisal of primary research has emphasized a distinction from the assessment of internal validity required for synthesized research. This assessment is conceptualized and branded in various ways in the literature, such as risk of bias, critical appraisal, study validity, methodological quality, and methodological limitations. This paper provides a discussion of the definitions and characteristics of these terms, concluding with a recommendation for JBI to adopt the term "risk of bias" assessment.

The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials.

JBI recently began the process of updating and revising its suite of critical appraisal tools to ensure that these tools remain compatible with recent developments within risk of bias science. Following a rigorous development process led by the JBI Effectiveness Methodology Group, this paper presents the revised critical appraisal tool for the assessment of risk of bias for randomized controlled trials. This paper also presents practical guidance on how the questions of this tool are to be interpreted and applied by systematic reviewers, while providing topical examples. We also discuss the major changes made to this tool compared to the previous version and justification for why these changes facilitate best-practice methodologies in this field.

Assessing the risk of bias of quantitative analytical studies: introducing the vision for critical appraisal within JBI systematic reviews.

A key step in the systematic review process is the assessment of the methodological quality (or risk of bias) of the included studies. At JBI, we have developed several tools to assist with this evaluation. As evidence synthesis methods continue to evolve, it has been necessary to revise and reflect on JBI's current approach to critical appraisal and to plan a strategy for the future. In this first paper of a series focusing on risk of bias assessment, we introduce our vision for risk of bias assessment for JBI. In future papers in this series, the methodological approach taken for this revision process will be discussed, along with the revised tools and guidance for using these tools.

Revising the JBI quantitative critical appraisal tools to improve their applicability: an overview of methods and the development process.

JBI offers a suite of critical appraisal instruments that are freely available to systematic reviewers and researchers investigating the methodological limitations of primary research studies. The JBI instruments are designed to be study-specific and are presented as questions in a checklist. The JBI instruments have existed in a checklist-style format for approximately 20 years; however, as the field of research synthesis expands, many of the tools offered by JBI have become outdated. The JBI critical appraisal tools for quantitative studies (eg, randomized controlled trials, quasi-experimental studies) must be updated to reflect the current methodologies in this field. Cognizant of this and the recent developments in risk-of-bias science, the JBI Effectiveness Methodology Group was tasked with updating the current quantitative critical appraisal instruments. This paper details the methods and rationale that the JBI Effectiveness Methodology Group followed when updating the JBI critical appraisal instruments for quantitative study designs. We detail the key changes made to the tools and highlight how these changes reflect current methodological developments in this field.

Achieving Quality Integrated Care for Adolescent Depression: A Scoping Review.

INTRODUCTION: While primary care is often the first point of contact for adolescents with depression, more than half of depressed adolescents are either untreated or undertreated. A scoping review had been completed to summarize approaches for achieving quality integrated care in primary care focused on adolescent depression. METHODS: The scoping review followed the methodological framework for scoping studies from Arksey and O'Malley. Articles were grouped into themes and mapped to 6 quality domains for integrated care from the practice integration profile survey and 3 levels of stakeholders based on WHO's definition for health systems (patient/family, primary care team, and national/sub-national health system). RESULTS: A total of 868 records were screened resulting in 22 articles at the patient/family-level (5/22), the primary care team-level (18/22), and the national/sub-national health system-level (16/22). The results highlighted multilevel approaches to support the delivery of quality integrated care for adolescent depression in primary care: (1) population-focused using patient registries, routine screening based on standardized algorithms, and patient-centered strategies, (2) team-driven where primary care clinicians collaborate with mental health clinicians as part of a primary care team, (3) evidence-based delivery of mental health services across the integrated care pathway from screening to follow-up visits, and (4) measurement-guided by leveraging the electronic health record infrastructure to learn from patient outcomes. CONCLUSION: More research is needed on how to provide quality integrated care for adolescent depression, specifically on patient engagement and retention, grounded in the frontline experiences of patients, families, and clinicians and supported by national and/or sub-national guidelines. A learning system could help integrate mental health services in primary care in a way that is consistent across the national and/or sub-national health system.

Building Research Capacity in Nursing Academia in 2020: Is the Road Less Perilous?

BACKGROUND: Building research capacity in nursing academic units continues to be a challenge. There are a number of external contextual factors and internal factors that influence individual faculty as well as the collective to engage successfully in research. PURPOSE: The overall aim of this opinion article is to provide an overview of the current external and internal, processes and structures, relevant to capacity of nursing faculty to engage in research. METHODS: To inform the external context, we reviewed national research funding trends for nursing. To inform the internal context, we provided an exemplar of the internal processes and structures designed to support research capacity building within our academic unit. RESULTS: Canadian Institutes of Health Research funding trends for research grants led by nurse principal applicants increased between 2010 and 2013, followed by a steady decline. In 2017 to 2018, there were only 24 research grants led by nurse principal applicants. These external challenges coupled with the traditional internal barriers, such as the imbalance between teaching and research time, threaten research capacity for nursing academics. CONCLUSION: Organizational strategies to promote research capacity within academic nursing units are a necessary requirement to move forward.