OA: Evidence-based interventions to reduce adverse events in hospitals: a systematic review of systematic reviews

BMJ Open

 Despite the widespread implementation of interventions to reduce patient harm, patient safety is not improving.2–4.

   None of the systematic reviews reported the conflicts of interest of the included studies (see online supplementary appendix 7). Six systematic reviews (10.0%) did not include a statement on the presence or absence of potential conflicting sources of support for carrying out the systematic review.42 ,45 ,46 ,52 ,68 ,78

The included reviews covered 14 patient-safety areas (table 1). Most of the reviews were about preventing adverse drug events (n=15), followed by infection prevention (n=8), delirium prevention (n=7) and adverse events after hospital discharge or clinical handover (n=7).

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Table 1

Identified systematic reviews (n=60) classified by patient-safety area (n=14)

Conclusions The evidence for patient-safety interventions implemented in hospitals worldwide is weak. The findings address the need to invest in high-quality research standards in order to identify interventions that have a real impact on patient safety. Interventions to prevent delirium, cardiopulmonary arrest and mortality, adverse drug events, infections and falls are most effective and should therefore be prioritised by clinicians.

Strengths and limitations of this study

• This review offers a unique overview of effective patient-safety interventions based on data from systematic reviews, thereby producing a stronger evidence-based oversight of effective interventions compared to the outcomes of a systematic review of primary studies.
• For several patient-safety interventions that are implemented worldwide, there is a lack of high-quality studies in which these interventions are evaluated.
• The found estimates of effectiveness of patient-safety interventions might vary across contexts, such as small versus large hospitals, academically affiliated hospitals versus those that are not and the availability of factors that stimulate successful implementation of interventions.