SAFEST concludes after four years

Turning European patient safety research into practice

After four years of European collaboration, the SAFEST project has reached the end of its Horizon Europe funding period. It leaves an evidence-based foundation for safer perioperative care, supported by practical recommendations, measurement tools, patient resources and approaches to implementation.

SAFEST stands for Improving quality and patient SAFEty in surgical care through STandardisation and harmonisation of perioperative care in Europe. Launched in June 2022 with almost €5 million in funding, the project brought together ten partner organisations from seven European countries, including ESAIC.

Its ambition was to improve and harmonise patient safety throughout the perioperative journey, from the decision to operate through hospital care and postoperative recovery.

A final conference focused on what comes next

The SAFEST Final Conference took place in Rotterdam on 5 June 2026, immediately before Euroanaesthesia 2026. It brought together 90 consortium members, clinicians, researchers, hospital representatives, patient-safety experts, patients, and representatives of professional organisations.

The conference went beyond presenting completed activities. Its programme focused on how SAFEST’s results could be applied, measured, and sustained after the project ended.

Sessions addressed patient empowerment, the SAFEST Compass and Core Measure Set, hospital self-evaluation, priority setting, implementation through the Perioperative Quality Improvement Learning Collaborative, project outcomes and the costs of improving perioperative safety.

During an interactive workshop, participants used SAFEST results to identify priorities and propose practical safety improvements. The conference also featured 29 posters presenting research, implementation experiences and good practices from participating hospitals and other centres. Three contributions received poster awards.

Establishing a common European foundation

One of SAFEST’s central achievements is the development of 101 evidence-based Perioperative Patient Safety Recommendations.

The recommendations cover 12 areas of perioperative safety, including organisational safety culture, staffing, communication, patient information, medication safety, infection prevention and the management of intraoperative and postoperative risks.

Their development involved more than reviewing the available evidence. Healthcare professionals, researchers, patients, and other stakeholders assessed their importance, clarity and feasibility across different healthcare settings.

The recommendations are available through the SAFEST Patient Safety Compass, where professionals and organisations can explore each one in detail.

The Compass provides hospitals with a common reference point. However, SAFEST also recognised that recommendations alone do not create change. Hospitals need to understand their current performance, identify their priorities, and receive support to implement improvements.

From assessment to action

SAFEST worked with ten hospitals in five European countries to examine how the recommendations could be assessed and implemented in different healthcare contexts.

The project developed a self-evaluation and benchmarking platform to help hospitals assess their adherence to the recommendations and identify areas for improvement. The process was designed not simply as an assessment, but as an opportunity for multidisciplinary teams to reflect on their patient-safety practices, discuss implementation across professional groups and recognise local strengths and priorities.

Hospitals can compare their results confidentially with aggregated data from peer institutions, supporting organisational learning and informed quality-improvement planning. More than 110 hospitals in Europe and beyond registered on the platform, demonstrating the wider relevance and sustainability potential of this collaborative approach.

“The greatest value of the SAFEST self-evaluation lies in transforming measurement into multidisciplinary reflection and benchmarking into shared learning. By helping hospitals identify strengths, prioritise improvement opportunities, and learn from one another, it creates a sustainable foundation for continuously strengthening perioperative patient safety.”

Claudio Rocha, Avedis Donabedian Research Institute

Participating hospitals used their findings to set priorities and develop local action plans. The Perioperative Quality Improvement Learning Collaborative then supported multidisciplinary teams as they put these plans into practice. Through training, shared learning and structured improvement methods, the collaborative helped teams adapt the recommendations to their local needs.

The project also developed a Core Measure Set to support more consistent evaluation of perioperative patient safety. Common measures can help hospitals determine whether improvements are producing meaningful results and support future comparisons across institutions and healthcare systems.

What the provisional evaluation found

The SAFEST evaluation followed 11,561 patients undergoing high-risk elective surgery in ten hospitals across five countries over 30 months. According to the public evaluation deliverable D6.2, the Learning Collaborative was associated with an immediate, statistically significant improvement in overall bundle adherence: 64.9%, compared with an estimated 61.7% without the intervention (odds ratio 1.26; 95% confidence interval 1.17–1.35; p<0.001).

The strongest and most sustained gains were seen in prehabilitation and intraoperative management. Nine of the 20 individual safety standards improved significantly, although the aggregate improvement was not maintained through the end of follow-up.

The adjusted rate of any complication was 13.8% during the programme, compared with an estimated 16.7% without the intervention. This difference of 2.9 percentage points, an approximate relative reduction of 17%, did not reach statistical significance (adjusted risk ratio 0.83; 95% confidence interval 0.60–1.11). Cardiovascular complications fell significantly, from an estimated 4.1% to 2.0% (adjusted risk ratio 0.48; 95% confidence interval 0.23–0.97).

These findings are provisional. Final analyses are being prepared for submission to a peer-reviewed journal and the figures may be refined before publication.

“Across more than 11,500 patients in ten European hospitals, SAFEST showed that a learning collaborative can rapidly improve perioperative safety practices, most clearly in prehabilitation and intraoperative care, alongside fewer observed complications. Sustaining these gains means embedding continuous monitoring, feedback and leadership commitment into everyday perioperative care.”

Paulo Sousa, Pedro Casaca and Ana Beatriz Nunes, SAFEST WP6

The evaluation also examined the conditions that supported or hindered implementation. Motivated teams engaged leadership and an established quality-improvement culture helped drive progress. Staff shortages, limited time, and frequent organisational changes created barriers. These findings are particularly important for organisations seeking to use SAFEST tools outside the original implementation hospitals.

Patients as partners in safer care

Patient involvement was built into SAFEST from the beginning. Patients contributed to developing and prioritising the recommendations, participated in project activities, and helped the consortium understand safety from the perspective of people moving through the surgical journey.

One of the project’s most practical results is the SAFEST Patient Checklist: Prepare Your Operation. The SAFEST Patient Advisory Board developed it with patients from participating hospitals and consortium members. It reflects what patients say they need to know before, during and after surgery.

Designed for adults preparing for planned surgery, as well as their family members and caregivers, the checklist helps patients prepare questions for their healthcare team, understand their treatment and recovery, and take a more active role in their care. It covers the full surgical journey, including medication, anaesthesia, safety checks, pain management, discharge, warning signs, and follow-up care.

Available in eight languages, the checklist does not replace medical advice. Instead, it provides a structure for clearer conversations between patients and healthcare professionals.

The final conference also included a dedicated interactive session on patient empowerment. Participants explored how tools such as the checklist can move patient participation from consultation into everyday safety practices.

Connecting SAFEST with the European professional community

ESAIC led the project’s communication and dissemination work. Over the four-year period, ESAIC helped communicate the project’s progress, share its resources, and connect its findings with the wider anaesthesiology and intensive care community.

Holding the Final Conference immediately before Euroanaesthesia 2026 allowed the consortium to present its work while professionals from across Europe were gathered in Rotterdam.

The conference also strengthened engagement with ESAIC’s National Anaesthesiologists Societies Committee (NASC). Representatives participated in the event and considered the relevance of the SAFEST recommendations for their national professional communities. Following this engagement, 12 endorsements were received through NASC representatives, marking an important step from dissemination towards professional recognition and future uptake.

The project also reached healthcare professionals through the European Hospital and Healthcare Federation (HOPE). During the open phase of the SAFEST self-evaluation, members of the HOPE network and other organisations took part in the benchmarking process. Some shared their experiences during the poster session at the Final Conference.

At the HOPE Agora 2026, several exchange participants were already familiar with SAFEST. Others showed a strong interest in learning more following presentations on the SAFEST Compass and the open phase of the Perioperative Patient Safety Initiative. This engagement provided further evidence that SAFEST had begun to reach beyond the consortium.

A national legacy in the Czech Republic

Spojená akreditační komise (SAK) coordinated two implementing hospitals and supported another hospital during the open self-evaluation phase. For SAK, SAFEST’s greatest impact was cultural. It strengthened awareness among Czech clinical teams of structured data management and established patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) as legitimate, actionable tools rather than administrative burdens.

Many teams engaged systematically with patient-reported outcomes and experiences for the first time, shifting local discussions towards genuinely patient-centred perioperative care. SAFEST also became a recurring topic at SAK’s annual national conferences, keeping the project’s standards and tools visible to Czech healthcare professionals beyond the consortium.

SAK’s participation in the systematic review underpinning the 101 recommendations, together with its contribution to the resulting scientific publications, provided valuable experience and strengthened the organisation’s methodological capacity. These combined changes in mindset, national visibility and scientific practice are among SAFEST’s most enduring legacies in the Czech Republic.

“SAFEST gave SAK a wealth of new scientific, managerial and developmental experience. Above all, it gave us the opportunity to build new partnerships and engage in the genuine knowledge-sharing on which every quality and safety system depends. For us, this network of trust is the project’s most valuable outcome.”

SAK, Country Coordinator, Czech Republic

A legacy beyond the project

The end of EU funding does not mark the end of SAFEST’s relevance. Its long-term value will depend on hospitals, professional societies, patients and policymakers continuing to use and develop its results.

Key outputs will remain available to hospitals, healthcare professionals and patients across Europe and beyond. These include the open-access SAFEST Compass, evidence-based patient-safety recommendations, training materials, the benchmarking platform and digital tools that help hospitals assess and improve the safety of surgical care.

In the short term, the SAFEST consortium will maintain these resources. The medium- to long-term ambition is to build a sustainable network for perioperative patient safety in collaboration with professional societies, accreditation bodies and health authorities. Aligning SAFEST with national patient-safety programmes and healthcare quality initiatives could allow more hospitals to adopt the standards, share learning, benchmark their progress and improve surgical safety.

“The true success of SAFEST will be measured by what happens after the project ends. By maintaining its recommendations, benchmarking platform, and digital tools, SAFEST creates a lasting foundation that hospitals can use to continuously improve patient safety.”

Dr Janika Blömeke-Cammin, OptiMedis AG

Cornel Riscanu, Project Adviser at the European Health and Digital Executive Agency (HaDEA), contributed to the conference’s opening. HaDEA manages Horizon Europe health projects on behalf of the European Commission.

“Improved quality of care and patient safety is one of the key priorities of the European Union. SAFEST is an important project in this regard, because it has provided valuable knowledge on how surgery-related adverse effects could be better addressed in different types of hospitals. However, to achieve wide and long-lasting impact, new knowledge and improved procedures should be embedded into international and national professional guidelines, so that each and every citizen may benefit, including beyond the European Union.”

SAFEST has shown what can be achieved when researchers, clinicians, hospitals, patients and professional organisations work towards a shared understanding of safer perioperative care.

The four-year project has now been concluded. Its next phase will be shaped by how its recommendations and tools are used in practice, and by the partnerships that continue the work of improving perioperative patient safety across Europe.

Explore the SAFEST Patient Safety Compass and learn more about the project at safestsurgery.eu.

This project received funding from the European Union’s Horizon Europe research and innovation programme under grant agreement No. 101057825. Views and opinions expressed are those of the author only and do not necessarily reflect those of the European Union or the granting authority. Neither the European Union nor the granting authority can be held responsible for them.

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