Patient safety in Marginalised Groups: A Narrative Scoping Review
Problem
Improving patient safety is at the forefront of healthcare policy and practice across the globe. Achieving equitable patient safety improvement however may be especially challenging in patients from marginalised groups or people considered to be 'outside of mainstream society'. Marginalised groups experience severe health inequities as well as increased risk of experiencing patient safety incidents. To date however no evidence exists to identify and map out the literature in this area in order to understand 1) which marginalised patient groups have been studied in terms of patient safety research, 2) what the particular patient safety issues are for these groups, 3) what contributes to these safety issues arising and 4) to develop a ‘conceptual model’ to further understand these issues.
Approach
A scoping review was conducted. Systematic searches were performed across six electronic databases in June 2018. The time frame for searches of the respective databases was from inception to June 2018 and limited to studies in the English language. No grey literature was included. Data was extracted,charted and coded.
Findings
The searches yielded 3118 articles, of which 63 articles were included. We identified fourteen different marginalised groups across all studies and 70% concerned just four marginalised groups. Thirteen separate patient safety issues were classified and just over half of the studies focused on three topics, the largest being medication safety. In total, 146 individual contributing or associated factors were identified and mapped to one or more of 7 different inductively derived domains. Patient safety issues were mostly multi-factorial in origin and a preliminary conceptual model for understanding patient safety vulnerabilities for marginalised groups was derived.
Consequences
This review indicates that marginalised groups are more likely to experience patient safety issues than mainstream populations they live alongside. Understanding which groups and/or individuals within these groups are most likely to experience safety issues and why, is a clear next step to informing how training, services and/or interventions might be designed to remove, or at the very least militate against these increased patient safety risks.