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Three years after the launch of the Helsinki Declaration on patient safety in anaesthesiology: The history, the progress and quite a few challenges for the future

Staender, Sven; Smith, Andrew; Brattebø, Guttorm; Whitaker, David

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European Journal of Anaesthesiology: November 2013 - Volume 30 - Issue 11 - p 651-654
doi: 10.1097/EJA.0b013e3283632d1e

A year before the amalgamation of the former European Society of Anaesthesiologists (former ESA), the European Academy of Anaesthesiology (EAA) and the Confederation of European National Societies of Anaesthesiologists (CENSA), and based on early and enthusiastic work by European anaesthesiologists, the scientific subcommittee ‘Patient Safety’ of the new ESA met for the first time in Lisbon in 2004. Members of that ESA subcommittee were Francois Clergue (CH), Sven-Erik Gisvold (N), Laszlo Vimlati (HU), Maurice Lamy (BE), Marcus Rall (DE), Andrew Smith (UK), Philippe Garnerin (CH) and Sven Staender (CH). Very soon this group became active. Safety meetings in Zurich and Oslo led to substantial input into patient safety activities at the Euroanaesthesia congresses in the subsequent years. A number of successful Euroanaesthesia meetings increased the group of dedicated people that started with the first of the annual European Patient Safety Courses (EPSC) directed by Marcus Rall in Copenhagen in 2008.

In parallel, the European Board of Anaesthesiology (EBA) of the European Union of Medical Specialists (UEMS, Union Européenne des Médecins Spécialistes) started with quality and safety activities in anaesthesiology back in the 1990s and published Guidelines for Safety and Quality in Anaesthesia Practice in the European Union in 2007.1 This subcommittee became a Standing Committee of the EBA at Riga in 2008 whose members at that time were Flavia Petrini (I), Guttorm Brattebø (N), Laszlo Vimlati (HU), Robert Fitzpatrick (UK), Leon Drobnik (PL), Stefan Trenkler (SK), Carmel Abela (MT) and David Whitaker (UK).

In June 2009, with the enthusiastic support of Jannicke Mellin-Olsen, Hugo Van Aken, Hans Knape and Paolo Pelosi, it was agreed to develop a Declaration on Patient Safety in Anaesthesiology to be launched during the Euroanaesthesia congress in Helsinki the following year after a drafting meeting in London in November 2009.2,3 This declaration constituted a milestone of the patient safety work of ESA, EBA and the National Anaesthesia Societies Committee (NASC). The aims of that Declaration were simple, ambitious and powerful, representing a shared European opinion about what was worth doing and at the same time practical, to improve patient safety in anaesthesiology. It recommends practical steps that all anaesthesiologists as well as national anaesthesia societies who are not already using them, should adapt for their own practice.

After the initial signing of the Helsinki Declaration by the ESA member national societies in 2010, the Declaration has been signed by industry representatives and patient organisations and over the past 3 years news of its existence has spread around the world. Today the Helsinki Declaration on Patient Safety in Anaesthesiology has been signed or has been adopted by a variety of countries and societies worldwide.

In parallel, the ESA and EBA set up a joint Task Force Patient Safety in 2010 in order to support the distribution of the aims of that Declaration. This Task Force consists of four anaesthetists, two representing ESA (AS, SS) and two representing the EBA (DW, GB). The aims of the Task Force were to create knowledge as well as resources for patient safety in order to help the implementation of the Helsinki Declaration. The Task Force has completed a wide variety of activities over the past 3 years. Among them are the template for a Departmental Safety report, a drug syringe labelling study (together with the University of Geneva and Berlin),4 a book on patient safety in anaesthesia distributed to every participant of Euroanaesthesia 2011 (Best Practice and Research Clinical Anaesthesiology, Hugo Van Aken, editor; Elsevier Science, June 2011),5 a survey on the use of capnography in Europe (presented at Euroanaesthesia 2012), a survey on the adherence to core contents of the Helsinki Declaration (presented at Euroanaesthesia 2013) and crisis checklists that should help with the management of critical situations in the perioperative setting. These crisis checklists were inspired and coauthored by David Borshoff.6 The first draft of the checklists was put together and a modified Delphi process was commenced with the content being sent to, and commented on, by invited and experienced anaesthesiologists all over Europe. After finalizing all this input, the final draft of the checklists was put on the members part of the ESA website and every ESA member was invited to comment. Thus, these crisis checklists are a compilation of European approaches to various crisis situations in the perioperative setting. The use of such checklists has been proven to be beneficial in a recent study from Harvard in which the authors found that failure to adhere to lifesaving processes of care was less common during simulations when checklists were available and the team performed better when the crisis checklists were available than when they were not.7

All of the content mentioned above has been put together in a starter kit together with various other resources on patient safety. The kit was distributed on a memory stick at this year's Euroanaesthesia 2013 Congress in Barcelona, Spain (1 to 4 June). To cater for the multiple aims of the Helsinki Declaration, the safety starter kit contains the following:

  1. selected articles of the publication ‘Safety in Anaesthesia’ (Best Practice and Research Clinical Anaesthesiology);
  2. an online basic guide on Patient Safety by Charles Vincent;8
  3. a proposed template for an anaesthesia departmental safety report;
  4. the text of the original Helsinki Declaration;
  5. hazard warnings published in countries that alert anaesthesiologists to important adverse events (examples provided from the UK, Germany and Switzerland);
  6. PowerPoint presentations and audio podcasts of essential aspects of patient safety; topics covered include human limitations in the operating room, an introduction to critical incident reporting, and so on;
  7. PowerPoint presentations from ESA and the WHO9 for basic lectures on patient safety/risk management including topics such as medication error, good communication and team work, simulation, engaging with patients and carers and understanding clinical risk;
  8. checklists for emergency management in the operating room, for situations such as those involving newborns, anaphylaxis, hypertension, hypotension, and so on;
  9. the WHO Safe Surgery Checklist;
  10. a list of links to important internet resources.

This starter kit will help to provide resources for all interested hospitals, departments of anaesthesiology or even national societies. Of course, many of the practices and tools referred to in the starter kit may be commonplace in many hospitals in Europe. But the ESA hopes that this starter kit will support hospitals, particularly those in countries that still have a long way to go before the standards of the Helsinki Declaration are fully established. Following Euroanaesthesia 2013, the ESA will publish the content of that kit in a dedicated section of its website (, and will also begin working on implementation of the Helsinki Declaration on a national level. This must be done in close cooperation with ESA, with EBA and the individual national societies themselves.

The survey on the European distribution of the content of the Helsinki Declaration performed by the Task Force Patient Safety revealed that only a few European countries have implemented all of the content of that declaration to date. This survey was conducted in 2012 among the representatives of the NASC and the ESA council members. Therefore, the broad implementation of the content of the Helsinki Declaration will be a major challenge for the future activities of ESA and EBA. The ESA will accompany this process of implementation with a strategy over the next few years. This strategy has been worked out with various experienced anaesthesiologists from Europe and has been approved by the ESA Board of Directors. It will focus on three major aspects over the next years:

  1. European coordination of activities and resources;
  2. national distribution and implementation;
  3. and, accreditation of national societies as well as local hospitals/trusts.

Table 1 shows the corresponding activities concerning communication and distribution and Table 2 shows the required action on a European and national as well as hospital level.

Table 1
Table 1:
Communication and distribution of the Helsinki Declaration on Safety in Anaesthesiology
Table 2
Table 2:
Action required on a European, national, and hospital level

The launch of the Helsinki Declaration on Safety in Anaesthesiology in 2010 was a major success following the important work of many anaesthesiologists in Europe over years. With the ‘starter kit’ we now have valuable resources available to continue improving patient safety in our hospitals. What is now required is the support and effort of all of us who care for patients every day in the perioperative setting to put the words of the Helsinki Declaration into practice – everywhere where we treat our patients.

Acknowledgements relating to this article

Assistance with the editorial: none.

Financial support and sponsorship: none.

Conflicts of interest: none.

Comment from the Editor: this Editorial was checked by the editors but was not sent for external peer review.


1. Mellin-Olsen J, O'Sullivan E, Balogh D, et al. Guidelines for safety and quality in anaesthesia practice in the European Union. Eur J Anaesthesiol 2007; 24:479–482.
2. Moreno RP, Rhodes A, Donchin Y. Patient safety in intensive care medicine: the Declaration of Vienna. Intens Care Med 2009; 35:1667–1672.
3. Mellin-Olsen J, Staender S, Whitaker DK, Smith AF. The Helsinki Declaration on Patient Safety in Anaesthesiology. Eur J Anaesthesiol 2010; 27:592–597.
4. Wickboldt N, Balzer F, Goncerut J, et al. A survey of standardised drug syringe label use in European anaesthesiology departments. Eur J Anaesthesiol 2012; 29:446–451.
5. van Aken H, Staender S, Mellin-Olsen J, Pelosi P. Patient safety in anaesthesiology. Best Pract Res Clin Anaesthesiol 2011; 25:ix–x.
6. Borshoff DC. Anaesthetic crisis manual. New York, USA:Cambridge University Press; 2011.
7. Arriaga AF, Bader AM, Wong JM, et al. Simulation-based trial of surgical-crisis checklists. N Engl J Med 2013; 368:246–253.
8. Vincent C. Essentials of patient safety – online. Wiley Publishing 2012. John Wiley & Sons Ltd: New York, USA. [Accessed 28 March 2013].
9. Slides to use with the WHO Patient Safety Curriculum Guide to Medical Schools. Geneva, Switzerland:World Health Organization; 2013; [Accessed 28 March 2013]
© 2013 European Society of Anaesthesiology