Reaching Consensus on a core outcome set for patient safety in perioperative care: SAFEST Project

BACKGROUND: In the European Union, 8 to 12% of patients admitted to hospitals experience adverse events, imposing a considerable burden on the health systems. The lack of standardised indicators to comprehensively analyse perioperative patient safety limits the evaluation of interventions to tackle this public health problem. This study aims to prioritise the most relevant and feasible core indicators to assess patient safety in perioperative care to develop a Core Outcome Set. METHODS: A two-round eDelphi was conducted. Sixty-seven experts were invited to participate and asked to independently rate indicators in importance and feasibility on a 9-point Likert scale. The indicators were grouped by the perioperative period and subgrouped by Donabedian's quality of care conceptual model Structure - Process - Outcome. Consensus to include was defined as ≥75% of experts scoring an indicator as 7 to 9, and 15% or less scoring 1 to 3. RESULTS: Forty-eight experts completed the Round 1 eDelphi survey, and 8 started the survey but did not complete it. Round 1 survey was answered by a diverse range of targeted categories of experts, including healthcare professionals (76.8%) and patients (10.7%). From the 247 indicators included in Round 1, 15.8% reached a consensus to include regarding both importance and feasibility. Across the perioperative period and Donabedian's quality of care conceptual model subgroups, a higher consensus to include was achieved regarding importance than feasibility. The results of Round 2 have yet to be available, as the study is ongoing. CONCLUSIONS: A consensus of a broad and heterogeneous panel of experts on core indicators for reporting perioperative patient safety was developed. While the experts highly punctuated the indicators' importance, the indicators' feasibility aspect needs to be further explored to implement effective and efficient monitoring and evaluation of surgical-related patient safety systems in clinical practice. KEY MESSAGES: • Prioritising indicators important for patients and the clinical practice is crucial to monitor and evaluate patient safety. • This consensus facilitates benchmarking across EU countries.