Impact of a dual-prevention nursing risk-management system on in-hospital adverse events, staff competence, and stakeholder satisfaction: a two-year quasi-experimental implementation study

BACKGROUND: In-hospital adverse events remain a leading cause of preventable harm, and nurses play a pivotal role in hospital-wide risk management. The dual prevention mechanism-integrating tiered risk classification with hidden-danger investigation-is well established in occupational safety but rarely operationalised across hospital-wide nursing services. We evaluated an integrated nursing risk-management system grounded in this mechanism. METHODS: In a 2-year, prospective, quasi-experimental implementation study (July 2022-July 2024) at Chifeng Municipal Hospital (Inner Mongolia, China), 49 clinical departments were allocated, at the unit level, to routine nursing management (control) or a structured dual-prevention system (intervention). Within these clusters, 120 nurses and 120 patients (60 + 60) were sampled. Outcomes were nursing-staff motivation, work quality, risk-management competence, the incidence of six adverse-event categories, and stakeholder satisfaction. Cluster-adjusted analyses used generalised estimating equations with Bonferroni correction; effect sizes are reported with 95% confidence intervals (CIs). Reporting followed SQUIRE 2.0 and TREND statement. As allocation was non-randomised, all estimates were interpreted as associations rather than causal effects. RESULTS: Baseline characteristics and foundational competence were equivalent between groups. After 2 years, intervention nurses showed higher self-assessed motivation (Δ = +9.3 points; 95% CI 7.2 to 11.4), peer-assessed motivation (Δ = +7.4; 95% CI 5.4 to 9.4), and higher work-quality scores (83.81 ± 5.65 vs. 77.24 ± 5.82; Cohen's d = 1.15). Total adverse-event incidence was lower in intervention than in control clusters (11.67% vs. 31.67%) (cluster-adjusted OR = 0.29; 95% CI 0.11 to 0.75; p = 0.008). Patient and physician satisfaction increased to 93.3 and 92.0%, respectively. Basic nursing competence was unchanged, indicating the selective improvement of higher-order behaviours. CONCLUSION: The dual-prevention system was associated with broad competence gains, fewer adverse events, and higher satisfaction. Given the non-randomised design, these findings should be regarded as preliminary. Further confirmation through multicentre cluster-randomised confirmation is warranted.