Patient SAFETY


Patient safety is defined by the WHO as:

"The prevention of errors and adverse effects to patients associated with health care"¹.

Patient safety has wide and varied application depending on the clinical and medical context

but is particularly relevant to patients undergoing surgery and other interventional

procedures. Hence anaesthesiologists have been among the very pioneers of patient safety,

working with surgical and other perioperative team members to ensure that patients are

protected from avoidable harm.

However, despite enormous advances in medicine and improvements in the delivery of care,

care that causes harm is nonetheless a leading cause of mortality and morbidity.

We believe that²

No one should be harmed in healthcare.

And yet...

 134 million

adverse events occur each year due to unsafe care in hospitals in low- and middle-
income countries, contributing to 2.6 million deaths annually


of hospital expenses can be attributed to treating patient safety failures in
OECD countries

4 out of 10

patients are harmed in the primary and ambulatory settings; up to 80% of harm in
these settings can be avoided

The Helsinki Declaration 

The Helsinki Declaration was launched at EuroAnaesthesia, ESA’s annual congress in 2010 as the result of collaboration between the European Society of Anaesthesiology (ESA) and the European Board of Anaesthesiology (EBA).

The Declaration represents a shared European opinion of what, currently, is both worth doing and practical to improve patient safety in anaesthesiology. It recommends steps that all departments and anaesthesiologists should implement in clinical practice, including supporting the WHO Safe Surgery Checklist, delivering annual patient safety reports, following patient monitoring and sedation standards and implementing protocols, including on infection control.

The Declaration also lists areas where steps must be taken to address numerous human and technical factors that can affect patient safety, including drug and syringe labelling, checking equipment, difficult or failed intubation, bleeding, infections, local anaesthetic toxicity and other rare but potentially lethal situations.

Finally, it requires data collection and analysis at multiple levels - anaesthesiology departments, hospitals, regions and countries - in order to measure, monitor and improve various indicators of patient safety. These includes mortality, morbidity, critical incidents, and adherence to best practices in the delivery of safe, high quality perioperative care.

To date, the declaration has gathered more than 300 signatories from across the world, including national, European and international societies of anaesthesiology, individual anaesthesiologists and anaesthesiology departments in hospitals, as well as patient representatives and industry supporters.

In 2020, the Helsinki Declaration will celebrate its 10 th anniversary. To mark this milestone, ESA will host its first Patient Safety Policy Summit.

 The Helsinki Declaration in practice – implementation status in 2020

Despite the importance of the Helsinki Declaration recommendations for patient safety during anaesthesia and surgery, a recent survey revealed that there are still significant gaps and variations in its implementation.

Based on 1.589 responses from 38 European countries, it was found that:

  • only one third of healthcare professionals (37.3%) confirmed that their hospital prepares an annual report on implemented safety measures

  • more than half of the respondents (54.3%) do not produce an annual report on morbidity and mortality

  • almost a quarter of respondents (23.2%) do not make use of incident reporting systems at all, or only sometimes use them

  • more than a fifth of respondents (21.9%) do not use, or only sometimes use the WHO Safe Surgical Checklist

  • almost a quarter of respondents (24.2%) were unsure which sedation standards their hospital uses

  • only one third (37.2%) of respondents contribute to national audits of safe practice.

The trend that emerges from the survey is that implementation of patient safety tools and practices vary according to the level of political support. We urge policymakers to ensure that minimum standards of care are met across Europe.


Find out more about our work on patient safety in anaesthesiology.