Peer Review in Patient Safety for Anaesthesiology and Intensive Care (PRiPSAIC)
Enhancing patient safety in European anaesthesiology
This project is kindly supported by
About PRiPSAIC
- Proposal
- Why?
- Why now?
- How are we doing this?
- What is the aim?
Networks of anaesthesiologists and critical care physicians are being established, equipped with the necessary tools and support to examine their own practices as well as those of their peers. This initiative aims to gather insights to inform the design of future solutions.
Research into the state of patient safety within European anaesthesiology and the adoption of the Helsinki Declaration has uncovered numerous positive findings. The focus will now shift from investigation to action.
Anaesthesiology and critical care staff have been pivotal during the COVID-19 pandemic, gaining unprecedented public attention. There is a strong commitment to developing safe, sustainable care as health systems evolve to accommodate the ‘new normal’.
The ESAIC collaborates with industry partners and national societies in anaesthesiology and intensive care across selected European countries, aiming to identify and connect ‘change champions’ and ambassadors committed to improving patient safety in hospitals.
Engagements have taken place with patient safety peer-review networks in four European countries, where participants receive training on evaluating patient safety. This initiative employs the implementation methodology and visit process from the Helsinki Declaration evaluation project, enabling an international exchange of knowledge and experiences in patient safety within anaesthesiology.
Achievements in patient safety from this initiative are regularly highlighted in ESAIC newsletters, showcasing the progress and impact of the work being undertaken.
A practical ‘toolkit’ will be made available for download, designed to assist in collaborating with peers for the guided assessment of patient safety practices in anaesthesiology departments. This toolkit aims to facilitate the development of strategies for advancing safer care and bolster the further implementation of the Helsinki Declaration.
The aim of the project is to:
- Create renewed interest in patient safety, and greater visibility for those working towards it
- Share and implement knowledge and good practice
- Give anaesthesiologists the tools they need to learn from their own data and practice, and from each other
- Promote relationships between academic, clinical and industry stakeholders in safety
Background
Preventable patient harm is an important challenge in anaesthesiology and perioperative care. As a response, the Helsinki Declaration on Patient Safety in Anaesthesiology was launched in 2010 by the ESAIC and European Board of Anaesthesiology, and has been widely recognised as a practical framework for improving patient safety. It set out a vision for patient safety in anaesthesiology and laid down specific standards which European anaesthesiologists might aspire to in practice. It was signed by all European national societies of anaesthesiology and many international societies. Further, although the speciality of anaesthesiology has been at the forefront of patient safety, it is a policy priority in healthcare generally worldwide.
Our previous project (‘Evaluation of the extent of implementation of the Helsinki Declaration for Patient Safety in anaesthesiology: a mixed-methods action research project’) ran for two years, between April 2018 and March 2020. It was generously supported by our ESAIC industry partners.
One of the recommendations from the project to further improve safety was to pilot and evaluate the establishment of small networks of interested anaesthesiologists and hospitals to carry out peer review visits assessing patient safety in each other’s hospitals, using the visit tool developed as part of the third phase of the project above.
As part of the data collection of the project, we asked anaesthesiologists at participating hospitals to complete a questionnaire to capture their perceptions of the visit process. One question asked about the feasibility of conducting the process without an external ‘visitor’. We had responses from 14 of the 21 participating departments. The general view was that having someone objective, impartial and confidential from the same country to visit, supported by national anaesthesiology societies, would be better than a pure self-assessment. This project takes its inspiration from this finding and aims to put it into practice.
Our work showed that there was widespread appreciation of, and compliance with, the Helsinki Declaration. However, we identified other areas needing attention:
- The relationship between departments of anaesthesiology and the rest of the hospital
- The changing nature of surgical patients – many are older and sicker than 10 years ago
- Financial and production pressures in anaesthesiology
- Migration of anaesthesiology personnel across national borders
- Departments of anaesthesiology tend to work independently and there is little ‘networking’
- The need for a way of evaluating patient safety locally without relying on external ‘experts’
Since then, the COVID-19 pandemic has put great strain on those working in anaesthesiology and intensive care and has also shown the public and governments how vital our work is within the healthcare system. It has also become clear that we need to learn from each other, learn lessons from the pandemic, and collect and learn from good, meaningful data about safety. There has never been a better time to invest in safety in anaesthesiology and intensive care, and this project will make the most of this opportunity.
Work undertaken
The ESAIC, through its National Anaesthesia Societies Committee, collaborated with National Anaesthesiology Societies Committee to select four countries with strong national backing for piloting a new project. In each chosen country, anaesthesiologists from several hospitals dedicated their time to running this project.
These networks organised patient safety visits, which differed from any current inspections and accreditations. These visits were led by anaesthesiologists familiar with the practical context of their peer’s work. The aim was to support hospitals in examining their own safety culture and practices from within.
The project adopted a ‘cascade’ approach: as one country commenced its activities, it hosted representatives from the next country’s network, promoting standardization of the implementation process and allowing the exchange of insights on patient safety practices and cultures across borders.
The visits consisted of a review of safety documents, safety attitude questionnaires, interviews with key stakeholders and observation of practice.
Particular areas of interest were:
- How anaesthesiology and Intensive Care interact with, and influence, the rest of the hospital: problems and opportunities
- Workforce problems and solutions: number, skill mix and wellbeing
- Safety in the Intensive Care Unit
- Perioperative care: preoperative assessment and postoperative management
- Data on safety and quality – how data are used, collected analysed and acted upon, and how digitalisation helps or could help, work in the future
- Day case surgery and the potential for expanding it whilst maintaining safety and quality
- Learning from the legacy of the COVID-19 pandemic
- Learning from error
- Opportunities for networking with colleagues regionally and nationally
- Opportunities for making healthcare safer and of higher quality whilst at the same time maintaining staff satisfaction and morale
A comprehensive communication strategy will be developed to promote the project to other countries. Data collection will enable evaluation of the project’s impact on safety and the perceptions of the visiting network, documenting both positive and negative influences to facilitate a successful larger-scale rollout.