Periodic Reporting for period 2 - SAFEST (Improving quality and patient SAFEty in surgical care through STandardisation and harmonisation of perioperative care in Europe)
Reporting period: 2023-12-01 to 2025-05-31
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.
Over the second period (from December 2023 (M19) to May 2025 (M36)), the SAFEST has completed a series of key activities and achieved significant milestones. Over this period, the consortium has focused on aligning hospitals shared improvement aims and developing action plans for launching and implementing the Perioperative Quality Improvement Learning Collaborative (PQILC), which officially began in June 2024. In parallel, preparations were also made for the launch of the open phase of the self-evaluation. During this time, the SAFEST consortium successfully achieved several key project milestones, including:
SAFEST Practices in Perioperative Care
1. Finalized SAFEST standardized practices, refined through iterative self-evaluation feedback.
2. Translated 101 safety recommendations into nine languages for wider accessibility.
3. Launched the interactive COMPASS mini-site for healthcare professionals, managers, and patients to consult perioperative safety guidance.
SAFEST Platform
4. Expanded the online platform to include self-evaluation, action planning, data collection, monitoring, benchmarking, and PROMs/PREMs registration.
5. Deployed monitoring and benchmarking modules for tracking adherence and surgical complication rates across hospitals.
6. Developed and tested a patient app (iOS/Android) for PROMs and PREMs, with supporting recruitment and data collection guidelines.
Hospital Self-Evaluation
7. Continued refining educational and training materials.
8. Published pre-intervention self-evaluation reports.
9. Launched an open-phase self-evaluation survey, supported by introductory webinars; ~30 hospitals have shown interest.
Evaluation & Monitoring
10. Conducted training and calibration exercises for data collectors; bi-monthly Q&A sessions provided ongoing support.
11. Ten hospitals began collecting data on SAFEST practice adherence and surgical outcomes.
12. Ten hospitals initiated PROMs and PREMs patient recruitment and data collection.
Prioritization & Action Planning
13. Identified common hospital-level priorities from self-evaluation results.
14. Supported hospitals in converting priorities into action plans; a live planning session was held in Prague.
15. Delivered a toolbox to assist with priority setting, barrier assessment, and action planning.
European Quality Improvement Collaborative (PQILC)
16. PQILC launched in June 2024, with 4 expert and 7 coaching sessions, including a live meeting in Nijmegen.
17. Deployed a context survey using the CFIR/IRLM framework to assess implementation conditions.
18. Began interviews to explore factors influencing collaborative learning.
19. Produced and shared summaries of all PQILC sessions to support ongoing learning.
Patient Empowerment
20. Identified, translated (Czech, Estonian, Portuguese), and adapted PROMs and PREMs scales.
21. Created patient journey maps per hospital and completed a cross-hospital analysis.
22. Developed an animated video on perioperative safety for patients, with English narration and subtitles in 8 languages.
SAFEST Practices in Perioperative Care
1. Finalized SAFEST standardized practices, refined through iterative self-evaluation feedback.
2. Translated 101 safety recommendations into nine languages for wider accessibility.
3. Launched the interactive COMPASS mini-site for healthcare professionals, managers, and patients to consult perioperative safety guidance.
SAFEST Platform
4. Expanded the online platform to include self-evaluation, action planning, data collection, monitoring, benchmarking, and PROMs/PREMs registration.
5. Deployed monitoring and benchmarking modules for tracking adherence and surgical complication rates across hospitals.
6. Developed and tested a patient app (iOS/Android) for PROMs and PREMs, with supporting recruitment and data collection guidelines.
Hospital Self-Evaluation
7. Continued refining educational and training materials.
8. Published pre-intervention self-evaluation reports.
9. Launched an open-phase self-evaluation survey, supported by introductory webinars; ~30 hospitals have shown interest.
Evaluation & Monitoring
10. Conducted training and calibration exercises for data collectors; bi-monthly Q&A sessions provided ongoing support.
11. Ten hospitals began collecting data on SAFEST practice adherence and surgical outcomes.
12. Ten hospitals initiated PROMs and PREMs patient recruitment and data collection.
Prioritization & Action Planning
13. Identified common hospital-level priorities from self-evaluation results.
14. Supported hospitals in converting priorities into action plans; a live planning session was held in Prague.
15. Delivered a toolbox to assist with priority setting, barrier assessment, and action planning.
European Quality Improvement Collaborative (PQILC)
16. PQILC launched in June 2024, with 4 expert and 7 coaching sessions, including a live meeting in Nijmegen.
17. Deployed a context survey using the CFIR/IRLM framework to assess implementation conditions.
18. Began interviews to explore factors influencing collaborative learning.
19. Produced and shared summaries of all PQILC sessions to support ongoing learning.
Patient Empowerment
20. Identified, translated (Czech, Estonian, Portuguese), and adapted PROMs and PREMs scales.
21. Created patient journey maps per hospital and completed a cross-hospital analysis.
22. Developed an animated video on perioperative safety for patients, with English narration and subtitles in 8 languages.
The SAFEST project is going beyond the state-of-the art in the following key areas:
• Standardised Safety Practices: Developed the first EU-wide, evidence-based perioperative safety practices through a stakeholder consensus process. Available in nine languages, the practices cover the full surgical pathway, including pre- and post-hospital care.
• Compass Tool: Created an interactive visual guide mapping 101 safety recommendations across 12 themes. Each is rated by feasibility, clinical importance, and patient relevance, with multilingual, lay and technical content accessible online.
• Core Measure Set (CMS-PSPC): Established 76 indicators for monitoring perioperative safety, developed with EU-wide stakeholders and patients. Includes structure, process, and outcome measures. An exploratory study informed future patient-centred refinements.
• Digital Platform & Toolbox: Launched a digital platform with tools for self-evaluation, action planning, data collection, and monitoring. Includes educational materials to support hospitals through the entire improvement process.
• Patient Involvement: Patient researchers contributed to journey mapping, PQILC advisory work, and coordinated the Patient Advisory Board to ensure strong patient voice and engagement.
• Policy Engagement: Interviews with national policymakers supported alignment of SAFEST tools with local strategies, enhancing sustainability and potential policy adoption.
• Standardised Safety Practices: Developed the first EU-wide, evidence-based perioperative safety practices through a stakeholder consensus process. Available in nine languages, the practices cover the full surgical pathway, including pre- and post-hospital care.
• Compass Tool: Created an interactive visual guide mapping 101 safety recommendations across 12 themes. Each is rated by feasibility, clinical importance, and patient relevance, with multilingual, lay and technical content accessible online.
• Core Measure Set (CMS-PSPC): Established 76 indicators for monitoring perioperative safety, developed with EU-wide stakeholders and patients. Includes structure, process, and outcome measures. An exploratory study informed future patient-centred refinements.
• Digital Platform & Toolbox: Launched a digital platform with tools for self-evaluation, action planning, data collection, and monitoring. Includes educational materials to support hospitals through the entire improvement process.
• Patient Involvement: Patient researchers contributed to journey mapping, PQILC advisory work, and coordinated the Patient Advisory Board to ensure strong patient voice and engagement.
• Policy Engagement: Interviews with national policymakers supported alignment of SAFEST tools with local strategies, enhancing sustainability and potential policy adoption.