Periodic Reporting for period 1 - SAFEST (Improving quality and patient SAFEty in surgical care through STandardisation and harmonisation of perioperative care in Europe)
Reporting period: 2022-06-01 to 2023-11-30
Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU) and are accountable for approximately EUR 21 billion in direct costs annually. Surgical adverse events are among the most common types reported. Adopting evidence-based practices can significantly improve the safety outcomes of surgical care. However, translating evidence into practice is slow in the healthcare field. Health systems encounter numerous challenges when attempting to incorporate evidence-based practices into clinical settings. These challenges include, for instance, a lack of awareness or trust among front-line professionals, insufficient consideration of patients' needs and preferences in the design and implementation of evidence-based practices, neglect of the implementation context, ineffective implementation strategies, and inadequate support from managers and decision-makers for health professionals. Therefore, having a set of patient-centred, evidence-based, practices with a high level of consensus and a comprehensive, tailored implementation strategy is a cornerstone to ensure access to safe, innovative, sustainable, and high-quality surgical care.
The SAFEST project aims to improve and harmonize perioperative patient safety by establishing and implementing widely supported perioperative patient-centred standardized practices. By studying the implementation of these practices, we will also identify contextual factors that inhibit or promote the adoption, implementation, and sustainment of evidence-based practices. This information will be used to develop recommendations on the implementation of the standards in hospitals in various contexts across Europe to reduce knowledge-practice gaps.
The SAFEST project aims to improve and harmonize perioperative patient safety by establishing and implementing widely supported perioperative patient-centred standardized practices. By studying the implementation of these practices, we will also identify contextual factors that inhibit or promote the adoption, implementation, and sustainment of evidence-based practices. This information will be used to develop recommendations on the implementation of the standards in hospitals in various contexts across Europe to reduce knowledge-practice gaps.
SAFEST project started in June 2022 and up to now (November 2023) it has completed a series of activities and reached several achievements. The project has been dedicated to the groundwork required for the forthcoming implementation of standards within the Perioperative Quality Improvement Learning Collaborative (PQILC), scheduled to commence in June 2024. This preparatory phase consisted of:
1. Formed Scientific expert group (SEG) and Scientific advisory group (SAG) for developing safest standardized practices and patient safety core outcomes.
2. Developed standardized practices for perioperative patient safety through systematic reviews and a consensus Delphi process.
3. Launched SAFEST Platform (beta) with self-evaluation tool, tools for monitoring practices adherence and surgical complications, manuals, and training materials.
4. Established evidence-based Core Outcome Set (COS) defining key metrics for perioperative patient safety.
5. Conducted pre-implementation strategy self-evaluation across 10 participating hospitals.
6. Compiled common standards priorities among hospitals, conducting preliminary research for hospital-level prioritization based on pre-self-evaluation analysis.
7. Conducted scoping review for deeper understanding of literature on sustaining quality improvement initiatives.
8. Formed Patient Advisory Board collaborating with SAFEST consortium throughout the project.
9. Conducted patient interviews in 10 SAFEST hospitals to gather perioperative experiences, needs, and preferences, informing priorities and actions for standards implementation within PQILC.
10. Conducted desk review to identify appropriate tools for Patient-Reported Experience Measures (PREMs) and Patient-Reported Outcome Measures (PROMs).
11. Examined policy and regulatory environment on perioperative patient safety through desktop search and 25 semi-structured interviews with decision-makers from each country in PQILC.
12. Developed Data Management Plan for guiding data collection, transfers, and storage throughout the project life cycle.
In addition, the project has made progress in identifying data extraction requirements and procedures to evaluate the effectiveness of the SAFEST strategy as well as, preparatory activities are underway for cost-analysis to determine the anticipated costs of implementing the strategy
1. Formed Scientific expert group (SEG) and Scientific advisory group (SAG) for developing safest standardized practices and patient safety core outcomes.
2. Developed standardized practices for perioperative patient safety through systematic reviews and a consensus Delphi process.
3. Launched SAFEST Platform (beta) with self-evaluation tool, tools for monitoring practices adherence and surgical complications, manuals, and training materials.
4. Established evidence-based Core Outcome Set (COS) defining key metrics for perioperative patient safety.
5. Conducted pre-implementation strategy self-evaluation across 10 participating hospitals.
6. Compiled common standards priorities among hospitals, conducting preliminary research for hospital-level prioritization based on pre-self-evaluation analysis.
7. Conducted scoping review for deeper understanding of literature on sustaining quality improvement initiatives.
8. Formed Patient Advisory Board collaborating with SAFEST consortium throughout the project.
9. Conducted patient interviews in 10 SAFEST hospitals to gather perioperative experiences, needs, and preferences, informing priorities and actions for standards implementation within PQILC.
10. Conducted desk review to identify appropriate tools for Patient-Reported Experience Measures (PREMs) and Patient-Reported Outcome Measures (PROMs).
11. Examined policy and regulatory environment on perioperative patient safety through desktop search and 25 semi-structured interviews with decision-makers from each country in PQILC.
12. Developed Data Management Plan for guiding data collection, transfers, and storage throughout the project life cycle.
In addition, the project has made progress in identifying data extraction requirements and procedures to evaluate the effectiveness of the SAFEST strategy as well as, preparatory activities are underway for cost-analysis to determine the anticipated costs of implementing the strategy
The SAFEST project is going beyond the state-of-the art in the following key areas:
- We have developed a set of perioperative standardized patients' safety practices through an evidence-based consensus approach involving key stakeholders from all over Europe. To our knowledge this outcome is the first evidence-based consensus list of patient safety practices produced with a wide representation of Europe. In addition, to promote their implementation, the standards will be available in different languages (Czech, Dutch, Estonian, French, German, Portuguese, Russian, Spanish).
- We have integrated patient safety practices covering the entire patients’ surgical pathway beyond hospital care. This will be fundamental to cope the fragmentated care pathway provided to patients by providing a series of practices that will ensure patients safety even outside hospitals.
- A Patient Advisory Board was formed at the beginning of the project and patients’ representatives have been involved in all the phases of the project, from the development of the list of standardised practices to the development of core outs set to ensure their preferences and perspective were considered. Additionally, patients’ interviews were conducted in the 10 participating hospitals to inform priorities and actions for the implementation phase.
- Key policymakers from the countries of the participating hospitals have been interviewed to gather a comprehensive evaluation on how to translate evidence into practice. This will also ensure sustainability after the end of the project life.
- We have developed a set of perioperative standardized patients' safety practices through an evidence-based consensus approach involving key stakeholders from all over Europe. To our knowledge this outcome is the first evidence-based consensus list of patient safety practices produced with a wide representation of Europe. In addition, to promote their implementation, the standards will be available in different languages (Czech, Dutch, Estonian, French, German, Portuguese, Russian, Spanish).
- We have integrated patient safety practices covering the entire patients’ surgical pathway beyond hospital care. This will be fundamental to cope the fragmentated care pathway provided to patients by providing a series of practices that will ensure patients safety even outside hospitals.
- A Patient Advisory Board was formed at the beginning of the project and patients’ representatives have been involved in all the phases of the project, from the development of the list of standardised practices to the development of core outs set to ensure their preferences and perspective were considered. Additionally, patients’ interviews were conducted in the 10 participating hospitals to inform priorities and actions for the implementation phase.
- Key policymakers from the countries of the participating hospitals have been interviewed to gather a comprehensive evaluation on how to translate evidence into practice. This will also ensure sustainability after the end of the project life.