High-reliability hospital safety: adverse events, surveillance and multimodal strategies to reduce preventable harm

Abstract

Introduction: Hospital patient safety remains a major healthcare priority because preventable adverse events continue to occur in association with medications, infections, procedures, falls, communication failures, and transitions of care. Evidence demonstrates substantial variation in harm detection and indicates that institutional safety culture influences incident prevention and reporting practices. Objective: To systematically analyze recent evidence on hospital adverse events, contributing factors, and clinical, organizational, and nursing strategies aimed at reducing preventable harm. Methodology: A systematic review of recent publications was conducted through structured searching, screening, eligibility assessment, critical appraisal, and standardized data extraction. Studies addressing harm epidemiology, medication safety, nursing care, safety culture, surveillance, and preventive strategies were considered. Results: The evidence identified a multifactorial origin of hospital adverse events. Safety education produced favorable effects on professional safety culture, whereas organizational characteristics influenced the institutional consolidation of safer practices. Missed or rationed nursing care also emerged as an important patient-safety factor. The most consistent strategies combined surveillance, process standardization, medication reconciliation, interdisciplinary communication, and nonpunitive organizational learning systems. Conclusions: Sustainable reduction of hospital harm requires multimodal interventions embedded within clinical governance. Prevention should integrate leadership, safety culture, adequate staffing, organizational learning, continuous surveillance, and interdisciplinary participation rather than relying on isolated measures across diverse hospital settings. These coordinated actions also support resilience, timely risk detection, and sustained improvement across complex hospital care pathways and clinical environments.