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Discussion
The current systematic review highlighted the essential use cases of PSMSs towards improving patient safety within hospital settings. Notably, the majority of studies concentrated on drug safety and hospital infections accounting for 37.5% and 20.8% of the reviewed literature, respectively. This may imply a higher perceived risk and prevalence of issues in these domains,44 45 as medication errors and healthcare-associated infections are among well-documented challenges in clinical settings.46 47 Accordingly, these issues have attracted more targeted research efforts and resource allocation in patient safety.48 The relatively low coverage of other patient safety areas could arise from their lower incidence in clinical practice or inherent challenges in effectively monitoring and documenting these safety issues. One significant factor can be attributed to the comparatively lower incidence of reported cases relative to medication errors and infections.49 This can foster a perception that these issues are less critical or frequent, resulting in fewer studies and interventions being directed toward them. Additionally, challenges in monitoring and documenting these safety concerns can hinder research and systematic reviews. For instance, areas such as patient falls, retained foreign items, and postoperative kidney injury, while significant, may lack the robust surveillance mechanisms established for drug-related adverse events and infections.49 The evidence on PSMSs is predominantly moderate in quality, with only 43.5% of studies meeting high-quality criteria. Common limitations include selection bias (small/single-centre samples), reporting bias (underdocumented safety events) and detection bias (manual data entry errors). While these constraints necessitate cautious interpretation, consistent findings across higher-quality studies suggest PSMSs can enhance safety monitoring.
The primary target groups identified in these studies were healthcare professionals, primarily physicians (40.6%) and nurses (26.1%). This emphasis on providers rather than patients reflects a traditional healthcare paradigm where patients are often viewed as passive recipients of care.50 A significant gap exists in the engagement of patients in their safety efforts.51 Empowering patients through initiatives such as personal electronic health records and patient portals could enhance safety measures and treatment adherence, allowing patients to take an active role in monitoring their health outcomes and fostering a sense of responsibility and agency.52 In a study, O’Leary et al reported that the implementation of tablets with a mobile patient portal application enhanced hospital patients’ understanding of their physician team members.53 When patients are empowered to participate in their care, they are more likely to communicate effectively with healthcare professionals, adhere to treatment plans and promptly report safety concerns.54 Consequently, involving patients in monitoring and decision-making can lead to improved safety outcomes and overall satisfaction with the healthcare experience.55 Transitioning towards a model that includes both healthcare providers and patients as active participants in patient safety initiatives appears to be essential for establishing a comprehensive and effective approach.56
Interestingly, the majority of PSMSs examined were hospital-wide systems, not specifically designed for bedside use. This limitation could hinder their effectiveness, as bedside interventions may offer more immediate and actionable data that can be used in real-time decision-making.57 Systems tailored to the bedside could potentially enhance patient safety by enabling direct, ongoing feedback from monitoring devices and fostering a more responsive approach to care delivery.58 The findings reveal a need for further research into the development and implementation of tailored bedside PSMSs that can be seamlessly integrated into existing workflows. Also, incorporating automated data feed capabilities into electronic health records can deliver real-time updates and alerts regarding patient status, medication schedules and potential safety concerns, thereby enabling proactive interventions by healthcare professionals.59 This integration can optimise workflow, minimise the risk of human error and ensure that healthcare providers have access to the most current and relevant information throughout the patient encounters.60 By integrating automated data, these systems can be transformed from passive data collection to a dynamic, real-time monitoring approach that enhances clinical decision-making and improves patient care outcomes.59
The duration and scope of implementing PSMSs significantly influence their effectiveness and patient safety outcomes. With implementation periods ranging from 2 months to 10 years, the average of 30 months indicates that longer integration often facilitates more comprehensive data collection and a better understanding of the systems’ impact. However, a shorter period of implementation may be accompanied by superficial integration and less impactful outcomes, especially in organisations that lack a supportive culture for patient safety.61 Such culture promotes transparency, encourages reporting and emphasises education as an essential component for maximising the benefits of PSMSs.62 Therefore, healthcare organisations must not only concentrate on the duration and sustainability of the implementation but also ensure a supportive organisational environment to enhance patient safety culture effectively.
Finally, the successful deployment of PSMSs entails a complex interplay of technical, organisational and social factors that extend beyond just technological implementation.31 Key elements include comprehensive training for healthcare staff, robust management support and the acceptance of new technologies within clinical environments, all of which contribute to cultivating a culture of safety.63 Effective training should be continuous and highlight the relevance of PSMSs, while the management team must actively advocate for safety initiatives to promote staff engagement.22 Furthermore, involving staff in the decision-making process can help alleviate resistance to change.64 Future research should investigate these interconnected dimensions across various hospital settings to identify best practices and facilitate the sustainable and effective implementation of PSMSs, ultimately enhancing patient safety and care quality.
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