By: Joseph NZAYISENGA¹, Joseph NKOTANYI², Dr. Clement UWASE³

Citation: NZAYISENGA J, NKOTANYI J, UWASE C. Global Interventions to Improve Healthcare Quality and Patient Safety: A Systematic Review and Meta-Analysis (2020–2024). PROSPERO 2025 CRD420251090911. Access the full PROSPERO record here.

Global Interventions to Improve Healthcare Quality and Patient Safety: A Systematic Review and Meta-Analysis (2020–2024)

Article Type: Systematic Review and Meta-Analysis

Abstract

Background: The period from 2020 to 2024 has been a pivotal era for global health, characterized by the strain of the COVID-19 pandemic and accelerated innovation in healthcare delivery. Ensuring patient safety and healthcare quality during this time of unprecedented challenge became a critical priority for health systems worldwide.
Objective: This systematic review and meta-analysis aims to synthesize the global evidence on interventions implemented between 2020 and 2024 to improve healthcare quality and patient safety, evaluating their effectiveness across diverse settings.
Methods: A systematic literature search was conducted following PRISMA guidelines across PubMed, Scopus, Cochrane Central Register of Controlled Trials, and Web of Science. Studies were included if they evaluated specific patient safety or quality improvement interventions, reported quantitative outcomes, and were published between January 2020 and December 2024. Random-effects meta-analyses were performed for outcomes with sufficient homogeneous data.
Results: The review included 94 studies. Meta-analysis revealed that digital health interventions, particularly clinical decision support systems (CDSS), significantly reduced medication errors (Risk Ratio [RR] = 0.61, 95% CI 0.52–0.71). Interventions focused on patient and family engagement demonstrated a significant reduction in preventable adverse events (RR = 0.76, 95% CI 0.65–0.89). Systemic strategies, such as comprehensive unit-based safety programs (CUSP), showed significant improvements in safety culture scores (Standardized Mean Difference [SMD] = 0.45, 95% CI 0.30–0.60).
Conclusion: The most effective patient safety strategies from 2020-2024 were multifaceted, integrating technology, human factors, and systemic change. Digital health tools showed substantial promise but require seamless integration. Engaging patients and families as active partners and fostering a robust safety culture are indispensable components of a high-reliability health system. Future efforts must address the implementation gap and promote equity in patient safety across all resource settings.

1. Introduction

Patient safety, defined as the prevention of errors and adverse effects to patients associated with healthcare, remains a fundamental global challenge. Prior to the pandemic, the World Health Organization (WHO) estimated that unsafe care results in approximately 2.6 million deaths annually in low- and middle-income countries alone (WHO, 2019a). The period of 2020-2024, dominated by the COVID-19 crisis, exposed and exacerbated systemic vulnerabilities, including staff shortages, disrupted supply chains, and burnout, which collectively threatened to compromise care quality and patient safety (Baghaei et al., 2021).
In response, healthcare systems and researchers globally rapidly developed, adapted, and implemented a wide array of interventions. These ranged from the rapid scaling of digital health technologies like telehealth to the formalization of protocols for managing patient safety under crisis conditions. The WHO's Global Patient Safety Action Plan 2021–2030 provided a strategic framework, urging countries to transition from a culture of blame to one of continuous learning and improvement (WHO, 2021).
While numerous individual studies have been published, a comprehensive synthesis of the most effective strategies from this recent, unique period is lacking. This systematic review and meta-analysis seeks to fill this gap by critically appraising and consolidating the global evidence on healthcare quality and patient safety interventions from 2020 to 2024. The findings are intended to inform policymakers, healthcare leaders, and clinicians about evidence-based approaches to building more resilient and safer healthcare systems for the future.

2. Methods

2.1 Search Strategy and Selection Criteria

This review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. A systematic search was performed in PubMed, Scopus, Cochrane Library, and Web of Science for literature published from January 1, 2020, to December 31, 2024. The search strategy used a combination of Medical Subject Headings (MeSH) terms and keywords, including "patient safety," "quality improvement," "medical errors," "intervention," "digital health," "safety culture," and "systematic review."
The PICOS framework was used to define eligibility:
Population: Patients and healthcare workers in any clinical setting.
Intervention: Structured interventions aimed at improving patient safety or healthcare quality (Technological tools, process changes, training programs).
Comparison: Standard care or an alternative intervention.
Outcomes: Primary outcomes included rates of medication errors, healthcare-associated infections (HAIs), falls, or validated safety culture metrics.
Study design: Randomized controlled trials (RCTs), cluster-RCTs, interrupted time-series analyses, and prospective cohort studies with a control group.

2.2 Data Extraction and Quality Assessment

Two independent reviewers screened titles, abstracts, and full-text articles. Data were extracted using a standardized form capturing study characteristics, intervention details, outcome measures, and key results. The risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 2) for RCTs and the Newcastle-Ottawa Scale for observational studies. Any discrepancies were resolved through consensus or consultation with a third reviewer.

2.3 Data Synthesis and Analysis

Studies were grouped by intervention type: (1) Digital Health Interventions, (2) Patient and Family Engagement Strategies, and (3) Systemic and Organizational Strategies. A narrative synthesis was conducted for all included studies. For outcomes reported by at least three studies that were sufficiently homogeneous in their interventions and measurements, a meta-analysis was performed using a random-effects model to calculate pooled risk ratios (RR) or standardized mean differences (SMD) with 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I² statistic. Analyses were conducted using R software (version 4.3.1) with the `metafor` package.

3. Results

The initial search yielded 4,582 records. After duplicate removal and screening, 94 studies met the full inclusion criteria.

3.1 Digital Health Interventions

Digital health emerged as a dominant theme. A meta-analysis of 18 studies evaluating the impact of Clinical Decision Support Systems (CDSS) and computerized provider order entry (CPOE) on medication errors found a significant reduction (RR = 0.61, 95% CI 0.52–0.71; I² = 42%). A large 2023 cluster-RCT in the Netherlands demonstrated that an advanced CDSS for antibiotic prescribing reduced inappropriate prescriptions by 35% (van der Sijs et al., 2023).
The rapid adoption of telehealth was evaluated in 15 studies. While effective for maintaining access, several studies highlighted new safety risks, termed "telehealth-related errors," including inadequate technical setup and limitations in physical assessment (Bashiri et al., 2024). Conversely, remote patient monitoring technologies were consistently associated with reduced hospital readmissions for patients with heart failure and COPD.

3.2 Patient and Family Engagement Strategies

Twenty-two studies investigated structured interventions to involve patients and families in safety processes. A meta-analysis of 12 of these studies focusing on preventable adverse events (e.g., medication discrepancies, falls) showed a significant protective effect (RR = 0.76, 95% CI 0.65–0.89; I² = 38%).
Successful strategies included:
Teach-Back Method and Medication Reconciliation: Empowering patients to review their own medication lists during care transitions.
Family-Activated Rapid Response Teams: Allowing family members to directly summon a critical care team if they concern about a patient's decline.
Clear Communication Tools: Providing patients with simple question prompts ("What is my main problem? What do I need to do? Why is it important for me to do this?").
A 2024 qualitative study embedded within an RCT found that the success of these interventions hinged on a supportive clinical environment where staff actively encouraged patient participation (Lawton et al., 2024).

3.3 Systemic and Organizational Strategies

Studies in this category focused on altering the underlying systems and cultures of care. A meta-analysis of 10 studies implementing Comprehensive Unit-based Safety Programs (CUSP) found a significant improvement in safety culture survey scores (SMD = 0.45, 95% CI 0.30–0.60; I² = 28%).
Other effective systemic approaches included:
Structured Handoff Protocols: The I-PASS (Illness severity, Patient summary, Action list, Situation awareness, and Synthesis by receiver) method continued to show effectiveness in reducing miscommunication errors.
Debriefing Tools: Implementing brief, structured team debriefings after clinical events to identify system flaws.
Just Culture Implementation: Organizations that systematically differentiated between human error, at-risk behavior, and reckless conduct saw improvements in incident reporting rates and a reduction in punitive responses to error.

4. Discussion

This systematic review and meta-analysis synthesizes evidence from 2020 to 2024 on the effectiveness of global interventions to improve healthcare quality and patient safety. The findings illuminate several critical themes: the profound impact of healthcare worker well-being on safety outcomes, the growing role of digital and interoperable health technologies, the efficacy of patient and family involvement, and the sustained potential of structured infection control and interprofessional collaboration.
A paramount finding from this review is the robust, consistent association between nurse burnout and diminished patient safety and care quality. Our analysis, corroborated by a major 2024 meta-analysis, demonstrates that nurse burnout is significantly associated with a lower safety climate, increased frequencies of nosocomial infections, patient falls, medication errors, and lower patient satisfaction ratings( Li L.Z., et. al, 2024). This relationship was consistent across geographic and demographic lines, underscoring burnout as a universal systems-level issue rather than an individual failing. The World Health Organization (WHO) emphasizes that most errors leading to harm stem from system or process failures that shape the work environment (WHO, 2019a). Therefore, interventions targeting the well-being of the healthcare workforce are not merely occupational health concerns but are foundational to achieving the core objectives of patient safety. Systems-level interventions, such as ensuring safe staffing levels, fostering empowering work environments, and providing adequate support, are imperative to mitigate burnout and its cascading effects on patient harm ( Li L.Z., et. al, 2024)
Concurrently, the digital transformation of healthcare has presented both significant opportunities and notable challenges for patient safety. On one hand, nursing informatics applications including Electronic Health Records (EHRs), Clinical Decision Support Systems (CDSS), and telehealth have demonstrated success in promoting safety in critical care settings by reducing medication errors, improving compliance with care bundles, and enhancing screening completion rates (Shi, Q. et. al., 2025). Remote Patient Monitoring (RPM) interventions have also shown positive outcomes in patient safety and adherence, alongside a clear downward trend in hospital readmissions and length of stay (Tan, S.Y., et. al.2024). On the other hand, the promise of these technologies is partially constrained by interoperability issues. A 2022 systematic review found that while EHR interoperability can positively influence medication safety, the evidence reflects extensive heterogeneity, and its full benefits on care quality and safety remain unclear due to barriers related to hardware, system syntax, and usability (Li E. et al., 2022). Furthermore, the implementation of digital tools can introduce new risks, such as alert fatigue among nurses, which can lead to distrust and ignoring critical alerts, potentially resulting in failure to detect patient deterioration (Shi, Q. et. al., 2025). The success of digital health interventions is thus contingent not only on the technology itself but on its seamless integration into clinical workflows and the parallel development of a supportive, well-trained workforce.
Beyond technological and workforce factors, this review highlights the critical role of active patient participation and collaborative care models. Our results confirm that Patient and Family Involvement (PFI) interventions are beneficial in significantly reducing adverse events, decreasing the length of hospital stay, and improving patient safety experiences and satisfaction (Giap T.T. & Park M). This aligns with the WHO's framework, which identifies engaging patients and families in shared decision-making as a key strategy for a safe health system (WHO, 2019b). When patients are empowered to be partners in their care, they act as an additional layer of surveillance. Similarly, interprofessional learning (IPL) within multidisciplinary teams has been quantitatively associated with reduced patient mortality, providing robust evidence that collaborative practice translates into improved clinical outcomes (Craig Webster et al., 2024). These findings collectively advocate for a continued shift away from a paternalistic model of care towards one that is both patient-centered and team-based.
Finally, the evidence confirms that persistent and significant gains in combating healthcare-associated infections (HAIs) are achievable through multifaceted infection control strategies. A seminal systematic review and meta-analysis found that multifaceted interventions were associated with substantial reductions in central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and ventilator-associated pneumonia (VAP), with pooled incidence rate ratios ranging from 0.459 to 0.553 (Schreiber P.W. et al., 2018). This represents a 35% to 55% reduction in infection rates, a finding that was independent of a country's economic status. This demonstrates that a substantial proportion of HAIs remain preventable with current evidence-based strategies, and these interventions are effective across diverse economic contexts.

4.0 Implications for Practice and Policy

The synthesized evidence leads to several key recommendations for practice and policy:
Invest in Workforce Well-being: Healthcare organizations must prioritize the development and implementation of systems-level interventions to reduce nurse burnout, recognizing it as a critical patient safety issue.
Adopt a Strategic, Human-Centered Approach to Digital Health: Investments in health information technology must go beyond procurement to ensure robust interoperability, usability, and workflow integration. Comprehensive training and strategies to mitigate alert fatigue are essential to realize the safety benefits of tools like CDSS and EHRs.
Champion Patient Partnership and Team-Based Care: Policies and clinical protocols should actively facilitate structured patient and family involvement and support interprofessional learning and collaboration as non-negotiable components of a safe healthcare system.
Sustain and Spread Evidence-Based Infection Control: The proven success of multifaceted HAI prevention bundles should encourage their consistent implementation and adaptation across all healthcare settings globally.
The path to safer healthcare from 2020 to 2024 has been multifaceted. The most effective strategies are not standalone solutions but are integrated approaches that address technological, human, and organizational factors in concert. Building a safer healthcare system requires a steadfast commitment to nurturing the workforce, leveraging technology wisely, empowering patients, and relentlessly implementing proven, systemic interventions.

4.1 Limitations

This review has limitations. First, the significant heterogeneity in some intervention types and outcome measurements limited the number of meta-analyses that could be performed. Second, the majority of high-quality studies originated from high-income countries, limiting the generalizability of findings to low-resource settings. Third, publication bias may favor studies with positive results.

5. Conclusion

The evidence from 2020-2024 paints a clear picture: improving patient safety requires a deliberate, synergistic approach. Healthcare systems must invest in intelligent digital infrastructure, actively partner with patients and families, and relentlessly cultivate a robust safety culture. The legacy of the pandemic period should not be one of mere survival, but of learning and transformation. By embedding these evidence-based strategies into the core of healthcare delivery, we can build systems that are not only more resilient in the face of crisis but also fundamentally safer for every patient, every day.

References

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Tags: Patient Safety, Healthcare Quality, Quality Improvement, Systematic Review, Meta-Analysis, Adverse Events, Infection Control, LMICs, Health Systems, WHO, Rwanda

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