Perioperative patient safety recommendations: best practices derived from a systematic review and a multidisciplinary expert consensus

Abstract Surgery care has one of the highest pooled prevalence of preventable patient harm. Many clinical practice guidelines have been developed around the world to overcome this safety and public health concern. Moreover, clinical practice guideline (CPG) recommendations may efficiently provide a sound source of evidence-based practices for quality indicator development. However, the question is which healthcare processes should be measured. The “Improving quality and patient SAFEty in surgical care through STandardisation and harmonisation of perioperative care in Europe” (SAFEST) project aimed to reach a Europe-wide consensus on perioperative patient safety recommendations for adults that will be further transformed in quality measures and guide implementation activities. To achieve such a goal, a systematic review of CPGs was performed, identifying more than 250 CPGs and more than 2600 recommendations; eventually selected and synthesized into 99 recommendations. Then, we recruited an expert panel including organisations from the European Region, and focusing on a balanced representation of geographical location, clinical and non-clinical expertise, and gender. A two-round online Delphi was conducted, and a Consensus Conference was held in Brussels. During the entire process, some recommendations were reworded, separated, merged, added or removed. Additionally, feasibility and equity concerns emerged and were further explored in-person during the conference. Finally, a list of 101 perioperative patient safety recommendations was agreed. These evidence-based practices incorporate clinical and managerial experts’ considerations as well as patient representatives’ reflections. In conclusion, this presentation will explore the relationship between recommendations and quality of care indicators. We will discuss the usefulness of SAFEST evidence-based recommendations, and their pros and cons as process and structure quality measures.