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Patient safety and the role of the Helsinki Declaration on Patient Safety in Anaesthesiology

A European survey

Wu, Henry H.L.; Lewis, Sharon R.; Čikkelová, Mirka; Wacker, Johannes; Smith, Andrew F.

European Journal of Anaesthesiology: December 2019 - Volume 36 - Issue 12 - p 946–954
doi: 10.1097/EJA.0000000000001043

BACKGROUND The Helsinki Declaration on Patient Safety was launched in 2010 by the European Society of Anaesthesiology and the European Board of Anaesthesiology. It is not clear how widely its vision and standards have been adopted.

OBJECTIVE To explore the role of the Helsinki Declaration in promoting and maintaining patient safety in European anaesthesiology.

DESIGN Online survey.

SETTING A total of 38 countries within Europe.

PARTICIPANTS Members of the European Society of Anaesthesiology who responded to an invitation to take part by electronic mail.

MAIN OUTCOME MEASURES Responses from a 16-item online survey to explore each member anaesthesiologist's understanding of the Declaration and compliance with its standards.

RESULTS We received 1589 responses (33.4% response rate), with members from all countries responding. The median [IQR] response rate of members was 20.5% [11.7 to 37.0] per country. There were many commonalities across Europe. There were very high levels of use of monitoring (pulse oximetry: 99.6%, blood pressure: 99.4%; ECG: 98.1% and capnography: 96.0%). Protocols and guidelines were also widely used, with those for pre-operative assessment, and difficult and failed intubation being particularly popular (mentioned by 93.4% and 88.9% of respondents, respectively). There was evidence of widespread use of the WHO Safe Surgery checklist, with only 93 respondents (6.0%) suggesting that they never used it. Annual reports of measures taken to improve patient safety, and of morbidity and mortality, were produced in the hospitals of 588 (37.3%) and 876 (55.7%) respondents, respectively. Around three-quarters of respondents, 1216, (78.7%) stated that their hospital used a critical incident reporting system. Respondents suggested that measures to promote implementation of the Declaration, such as a formal set of checklist items for day-to-day practice, publicity, translation and simulation training, would currently be more important than possible changes to its content.

CONCLUSION Many patient safety practices encouraged by the Declaration are well embedded in many European countries. The data have highlighted areas where there is still room for improvement.

From the Lancaster Patient Safety Research Unit, University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, UK (HHLW, SRL, AFS), European Society of Anaesthesiology, Brussels, Belgium (MČ) and Institute of Anaesthesia and Intensive Care IFAI, Hirslanden Klinik, Switzerland (JW)

Correspondence to Andrew F. Smith, Department of Anaesthetics, Royal Lancaster Infirmary, Lancaster LA1 4RP, UK Tel: +44 7768 226361; e-mail:

Published online 1 July 2019

© 2019 European Society of Anaesthesiology