Following up the Helsinki Declaration

Following up the Helsinki Declaration

Session held on Monday 4 June

The Helsinki Declaration on Patient Safety in Anaesthesiology (HD), launched in 2010 by EBA and ESA, has been widely recognised as a practical framework for improving patient safety. It has been signed by all European National Anaesthesiologists Societies (NAS) and many international societies. Yet, surveys and reports suggest inconsistent or lacking implementation and adoption of the HD into clinical practice. The extent and causes of this problem remain unclear.

In this session, Dr Jannicke Mellin-Olsen, now President Elect of the World Federation of Societies of Anaesthesiologists (WFSA), and Dr Johannes Wacker, Chair of the Patient Safety and Quality Committee of ESA, discussed the HD and its features.

The “Principal Requirements” are a practical “bundle” of patient safety tools for institutions providing anaesthesia. Based on an increasing body of evidence, they include monitoring standards, safety-relevant protocols, checklists, the necessary facilities as well as data collection and reporting about patient safety and patient outcomes. Since the launch of the HD in 2010, ESA and its partner organisations have conducted numerous activities to help anaesthesiologists adopt the HD requirements. Despite these efforts, surveys suggest that this adoption is rather slow and incomplete in most European countries.

ESA has now started a research project to better understand potential obstacles. It is important to highlight, however, that many benefits of the HD requirements are well established, and directly in the interest of frontline clinicians – such as difficult airway or massive haemorrhage protocols and the necessary equipment and facilities. “Anaesthesiologists can instantly start to review the patient safety infrastructure of their institutions by using the HD as a checklist,” explained Dr Wacker. “Approaches to potential weaknesses can be adapted to local needs. Indeed, realisation of the HD requirements by convinced frontline clinicians seems more promising for sustained success than mere top down directives. By developing a comprehensive and actionable HD practice standard, ESA may be able to facilitate HD adoption in the future.”

Dr David Whitaker, Member of the ESA Patient Safety and Quality Committee and Chair of the EBA Patient Safety Committee, then considered the benefits of annual safety reports. Principal Requirement number 5 of HD is for all departments of anaesthesiology in Europe to produce an annual departmental patient safety report and a template for doing this is available on the ESA website. The first section briefly reports the department’s structure; number of procedures and other details, but the second section reviews the department’s patient safety achievements over the past year and sets the agenda for the next year’s improvement activity.

Dr Whitaker said: “Producing even such a simple report means anaesthesiologists in a department have to engage with the patient safety issues in their own clinical practice, identify some local problems, attempt to improve them and help to nurture a patient safety culture. “

He concluded: “Once a department has done this, it may wish to consider sharing the report within its own hospital to raise its departmental profile and the whole issue of patient safety with other specialities or even choose to share their achievements and learning with the ESA Patient Safety and Quality Committee (PSQC).”

The final part of the session was on the ESA project that will evaluate implementation HD, given by Dr Andrew Fairley-Smith, University Hospitals of Morecombe Bay NHS Foundation Trust, Morecombe, UK.  The first phase (year 1) will consist of an online survey to ESA members and interviews with key anaesthetists in all European countries.  In the second year, there will be a limited number of site visits to hospitals in a small number of countries (to be decided on the results from year 1).

Dr Fairley-Smith said: “In the second phase, we will really try to get under the skin of the survey respondents, with in depth interviews with practitioners and time observing their practice. We really need to understand why things are done as they are in their institutions. Although these methods are much more complex and expensive than surveys, they generate rich data and contextual understanding.”

He concluded: “This snapshot of patient safety in anaesthesiology in Europe will provide ESA with vital intelligence to inform future refinement of the Helsinki Declaration, as well as a better understanding of member nations/organisations’ safety structures.”