Leveraging digital technologies to enhance patient safety

Abstract

Aims This study aims to examine how digital technologies can be safely and effectively integrated into clinical practice to enhance patient safety, with a particular focus on emergency department triage. Background Patient safety remains a persistent challenge in high-pressure environments such as emergency care. The complexity of clinical workflows, cognitive demands on healthcare professionals, and system-level constraints often contribute to patient safety risks. While digital tools such as Clinical Decision Support Systems (CDSS) offer promise, their impact depends on how well they align with real-world decision-making processes. Methods A Cognitive Task Analysis (CTA) was conducted with triage nurses in the emergency department (ED) of Malta’s main acute hospital. The study involved semi-structured interviews and direct observations to elicit the cognitive challenges, decision strategies, and contextual constraints experienced during triage. Findings were synthesised into a Cognitive Demands Table to identify sources of risk and variation in decision-making. Results The CTA revealed key challenges affecting patient safety at triage, including cognitive overload, incomplete information, reliance on intuition, protocol deviations, communication gaps, and fatigue. These findings informed the development of a conceptual framework comprising six pillars essential for safe digital integration: governance and policy alignment, human-centred design, clinical validation, digital literacy, interoperability, and continuous monitoring. Conclusion Digital technologies have the potential to significantly improve patient safety, but their effectiveness depends on thoughtful integration into clinical environments. This study highlights the importance of designing digital systems that are context-aware, ethically governed, and co-developed with end users. The proposed framework offers practical guidance for healthcare leaders, developers, and policymakers seeking to embed safety into the digital transformation of care.