Learning together for safer care - the PRiPSAIC approach 

Patient safety improves when teams have time to examine how work is really done, learn from colleagues and translate that learning into practical change. The ESAIC’s PRiPSAIC project (Peer Review in Patient Safety in Anaesthesiology and Intensive Care) was developed to support exactly this approach.

Peer review visits are not a substitute for outcome measurement or formal regulation, and the evidence on their impact is not uniform. However, research suggests that they can support quality improvement when they are structured, trusted and followed by practical action. Recent work on peer-review visits in NHS services similarly found that they are more effective when experienced as opportunities for learning rather than compliance monitoring, with trust, knowledge exchange and follow-up influencing whether improvement is sustained.

PRiPSAIC builds on the Helsinki Declaration on Patient Safety in Anaesthesiology. Its purpose is not to inspect or rank hospitals but to create opportunities for departments to review their own safety practices with trusted peers, identify strengths and areas for improvement, and share ideas across institutions and countries. ESAIC’s Patient Safety and Quality Committee (PSQC) supports this work as part of its wider programme of research, education and collaboration in patient safety and quality of care.

What does a PRiPSAIC review involve?

The project uses a structured but adaptable peer-review process. A participating department prepares relevant safety documents and completes an annual departmental patient safety report. Team members are also invited to complete the safety attitudes questionnaire, providing insight into perceptions of teamwork, communication, management support, and how safety concerns are handled.

During the visit, members of the visiting and host teams discuss the evidence, interview staff, and undertake safety work rounds (e.g. observations of equipment checks, medication storage, WHO surgical briefings, time-out procedures, and handovers between teams).

The visiting team then prepares a short report highlighting positive practices, opportunities for improvement, and issues that may benefit from further discussion. This combination matters. Written policies show what an organisation intends to do. Conversations and observations help reveal how care is delivered in everyday practice. These visits also allow all members of the multidisciplinary team to describe what works well and where safer systems could be developed.

What has been achieved?

The initial PRiPSAIC work tested the feasibility of peer-reviewed networks in several European settings. Visits took place in Scotland, Lithuania, Finland and the Republic of Moldova, with participating departments learning from one another and colleagues joining visits in other countries. The project has produced an online toolkit designed to help departments establish local or national peer review networks. Its modular structure allows hospitals to begin with the elements most relevant to their circumstances and progress at their own pace.

The toolkit includes practical templates and guidance for organising reviews, collecting information and reflecting on findings. It is available free of charge through myESAIC, and participating hospitals can choose to share anonymised information and contribute to the learning community.

Since the original project, invited peer-reviewed visits have taken place in hospitals in the Netherlands, Turkey, Malta and Greece. Early experience suggests that peer review can do more than identify gaps. It can make existing good practice visible, connect colleagues who face similar challenges, and provide a constructive starting point for local improvement. The process also generates practical intelligence that can inform future ESAIC patient safety activities and research.

An invitation to ESAIC members

The next phase will depend on the involvement of interested individuals and institutions. ESAIC’s PSQC is establishing a research group of colleagues who would like to receive information about current and future patient safety projects. The ESAIC invited previous participants in its patient safety courses to join, but anyone interested in contributing is welcome.

The ESAIC plans to increase the number of PRiPSAIC visits from November 2026. Patient-safety experts and ambassadors may participate as members of visiting teams, while hospitals and departments may volunteer to host a review.

Preparatory online meetings are planned for late September or early October, followed by a further meeting in December to discuss the experience of visiting teams and host centres and consider future research and publication.

If you would like to be kept informed, please get in touch with Benedict Preckel at b.preckel@amsterdamumc.nl.

Please feel free to share this invitation with colleagues and institutions that may wish to take part.

PRiPSAIC offers a practical way to turn the principle of shared learning into action. By opening our departments to constructive peer discussion, we can strengthen safety culture, support frontline teams, and improve the reliability of care for patients across Europe.

Author: Dr Argyro Zoumprouli, MD, PhD
Hayler Senior Lecturer & Hon Consultant in Neuroanaesthesia & NeuroIntensive care
Patient Safety and Quality Committee – European Society of Anaesthesiology and Intensive Care
Simulation Committee – European Society of Anaesthesiology and Intensive Care
Neuro Anaesthesia and Critical Care Society Council (UK)
St. George’s University Hospitals NHS Foundation Trust

References

• Kaehne, A., Feather, J., & Simcock, T. (2026). Beyond Compliance: Understanding the Role of Peer Review Through a Theory of Change. Journal of Evaluation in Clinical Practice, 32(2), e70422. https://doi.org/10.1111/jep.70422
• Kilsdonk, M., Siesling, S., Otter, R., & Harten, W. V. (2015). Evaluating the impact of accreditation and external peer review. International Journal of Health Care Quality Assurance, 28(8), 757–777. https://doi.org/10.1108/IJHCQA-05-2014-0055
• PRiPSAIC. (2024, December 5). ESAIC. https://esaic.org/patient-safety/pripsaic/
• The Helsinki Declaration on Patient Safety in Anaesthesiology 2.0. (n.d.).