Epidemiology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
Public Health, Canadian Red Cross, Ottawa, Ontario, Canada.
BMJ Open Qual. 2023 Apr;12(2). doi: 10.1136/bmjoq-2022-002134.
The implementation and continuous improvement of patient safety learning systems (PSLS) is a principal strategy for mitigating preventable harm to patients. Although substantial efforts have sought to improve these systems, there is a need to more comprehensively understand critical success factors. This study aims to summarise the barriers and facilitators perceived by hospital staff and physicians to influence the reporting, analysis, learning and feedback within PSLS in hospitals.
We performed a systematic review and meta-synthesis by searching MEDLINE (Ovid), EMBASE (Ovid), CINAHL, Scopus and Web of Science. We included English-language manuscripts of qualitative studies evaluating effectiveness of the PSLS and excluded studies evaluating specific individual adverse events, such as systems for tracking only medication side effects, for example. We followed the Joanna Briggs Institute methodology for qualitative systematic reviews.
We extracted data from 22 studies, after screening 2475 for inclusion/exclusion criteria. The included studies focused on reporting aspects of the PSLS, however, there were important barriers and facilitators across the analysis, learning and feedback phases. We identified the following barriers for effective use of PSLS: inadequate organisational support with shortage of resources, lack of training, weak safety culture, lack of accountability, defective policies, blame and a punitive environment, complex system, lack of experience and lack of feedback. We identified the following enabling factors: continuous training, a balance between accountability and responsibility, leaders as role models, anonymous reporting, user-friendly systems, well-structured analysis teams, tangible improvement.
Multiple barriers and facilitators to uptake of PSLS exist. These factors should be considered by decision makers seeking to enhance the impact of PSLS.
No formal ethical approval or consent were required as no primary data were collected.
实施和持续改进患者安全学习系统（PSLS）是减轻可预防的患者伤害的主要策略。尽管已经做出了大量努力来改善这些系统，但仍需要更全面地了解关键成功因素。本研究旨在总结医院工作人员和医生认为会影响 PSLS 中报告、分析、学习和反馈的障碍和促进因素。
我们通过搜索 MEDLINE（Ovid）、EMBASE（Ovid）、CINAHL、Scopus 和 Web of Science，进行了系统评价和元综合。我们纳入了评估 PSLS 有效性的英语定性研究手稿，并排除了仅评估特定个体不良事件（例如仅跟踪药物副作用的系统）的研究。我们遵循 Joanna Briggs 研究所定性系统评价方法。
在筛选了 2475 篇符合纳入/排除标准的文章后，我们从 22 篇研究中提取了数据。纳入的研究主要集中在 PSLS 的报告方面，但在分析、学习和反馈阶段都存在重要的障碍和促进因素。我们确定了以下有效使用 PSLS 的障碍：资源短缺导致组织支持不足、培训不足、安全文化薄弱、问责制缺失、政策缺陷、指责和惩罚性环境、系统复杂、缺乏经验和缺乏反馈。我们确定了以下促进因素：持续培训、责任和问责之间的平衡、领导者作为榜样、匿名报告、用户友好型系统、结构良好的分析团队、切实的改进。
PSLS 的采用存在多种障碍和促进因素。决策者在寻求增强 PSLS 的影响时应考虑这些因素。
由于没有收集原始数据，因此不需要正式的伦理批准或同意。
