Building resilience in perioperative medicine: ensuring safe care for all

A White Paper from the European Society of Anaesthesiology and Intensive Care (ESAIC) 

Anaesthesiology at the heart of resilient healthcare systems 

by Prof. Wolfgang Buhre, ESAIC President 2024-2025 

Healthcare systems across Europe are under increasing pressure. Ageing populations, growing patient demand, workforce shortages, high workloads, unequal working conditions, shortages of medicines and devices, digital transformation, and the urgent need for environmental sustainability are reshaping how care is delivered. 

In this context, the ESAIC has published a comprehensive White Paper that addresses the role of anaesthesiologists in enhancing patient safety and building resilient, high-quality, and sustainable healthcare systems across Europe. 

In an interview marking the publication, Prof. Wolfgang Buhre, immediate past-President of the ESAIC, underlined why resilience must now be placed firmly on the agenda. 

‘We are in a changing environment,’ he explains. ‘In Europe, the population ages. Our patients need us. However, what we also learned during the pandemic is that we are not resilient enough to meet the demand.’ 

For Prof. Buhre, anaesthesiologists are central to this discussion. Across Europe, anaesthesiologists see approximately 70–80% of all hospital patients, often during their most vulnerable moments: in the emergency department, the operating theatre and the intensive care unit. This places the speciality in a unique position within multidisciplinary care, combining clinical expertise with a broad, patient-centred view of the hospital journey. 

The White Paper identifies three main priorities for action. 

First, it stresses the need to maintain a skilled and resilient workforce. Anaesthesiologists across Europe face workforce shortages, high workloads, burnout and unequal working conditions, all of which affect patient safety and healthcare efficiency. The ESAIC therefore advocates for EU-wide workforce planning, harmonised training standards through the European Training Requirement, mutual recognition of qualifications, and continuous clinical and non-clinical education. 

Second, the White Paper emphasises the need to protect the quality and safety of care. This includes the consistent implementation of perioperative quality standards, clearly defined roles for anaesthesiologists, multidisciplinary and patient-centred care, and shared decision-making. It also highlights the potential of digitalisation and artificial intelligence to improve efficiency and outcomes, while underlining the importance of anaesthesiologists’ oversight. The paper calls for a European perioperative patient registry and stronger policies to prevent shortages of essential medicines and medical devices. 

Third, the paper addresses environmental sustainability in anaesthesiology. Healthcare has a significant carbon footprint, and anaesthesiology has a responsibility to reduce the environmental impact of clinical practice, including the use of inhaled anaesthetics and single-use materials. The ESAIC promotes sustainable clinical practices and policy support to reduce emissions, waste and environmental harm while maintaining patient safety. 

The White Paper was developed through interviews with anaesthesiologists from 10 European countries, in-depth discussions with ESAIC Board members*, and extensive reviews of the literature and grey literature. It focuses on four pillars: education and training; best clinical practices; hospital management and quality of care; and healthcare sustainability. 

Together, these priorities position anaesthesiologists as key leaders in patient safety, healthcare resilience, innovation and sustainability. They also reflect ESAIC’s broader commitment to strengthening the profession and supporting healthcare systems prepared for the future. 

As Prof. Buhre notes in the interview, the ESAIC is calling on policymakers to recognise the wider role of anaesthesiology in resilient healthcare systems. ‘We should be involved. We should help. We should work together to bring that not only to the table, but also to make concrete steps to move forward,’ he says. 

The publication of this White Paper also comes at a symbolic moment, as Prof. Buhre’s term as ESAIC President comes to a close. Reflecting on the future of healthcare, he offers a clear final message: ‘The future of healthcare depends on the professionals who are able to perform healthcare.’  

You can find the White Paper in the June edition of the European Journal of Anaesthesiology here.

This White Paper is intended to serve as a valuable resource for policymakers, healthcare leaders and professionals across Europe. Its message is clear: investing in anaesthesiology means investing in safer patients, stronger systems and more sustainable healthcare for all.