Trends in Patient Safety Management Systems by Hospital Size in Japanese Acute Care Hospitals

National policies and efforts of medical associations have promoted patient safety management systems mainly in acute care hospitals. However, evidence on the long-term impact of these initiatives in Japan remains limited. This study assessed trends in patient safety systems and their implementation in Japanese acute care hospitals.

We conducted a secondary analysis of nationwide biennial surveys of patient safety managers from 2015 to 2023. Surveys targeted a stratified random sample of hospitals based on bed size and examined the implementation of systems for detecting and analyzing medical incidents, along with experiences of serious adverse events. Trend analyses by hospital size were conducted using the Cochran-Armitage test. Analyses were conducted as exploratory trend analyses using available-case data.

The organizational commitment to patient safety was well maintained, as reflected in the assignment of a safety manager and department. Adverse event reporting systems were widely adopted throughout the period, and systematic reviews of all inpatient deaths rose significantly (25.0% in 2015 to 70.5% in 2023). However, advanced incident analysis methods remained underutilized, particularly in small hospitals (<200 beds). The proportion of hospitals experiencing serious medical accidents increased, especially among large hospitals (≥400 beds).

Over the past decade, Japanese acute care hospitals have made notable progress in developing patient safety infrastructures. While foundational systems were widely implemented, adoption of advanced analytical tools remains uneven. The rise in reported serious events may reflect improved detection and identification capabilities, or a simple increase in medical accidents. Sustained policy support and customized strategies for smaller hospitals are essential for continued advancement.