Patient Safety

ESA Quality Indicator Project

Martin Ponschab (AU), Jan Hendrickx (BE), Johannes Wacker (CH)


As professionals in the perioperative setting, we all strive to continuously improve the safety and quality of care, but as the physicist Lord Kelvin reportedly said: “if you can’t measure it, you can’t improve it”. Hence, meaningful measures for safety and quality would be of utmost importance.

However, healthcare safety and quality are complex entities that cannot be assessed easily by using a single measure.1 Yet public awareness of and scientific interest in these topics are increasing. Results from research projects and routine data collections suggest that up to 50% of adverse events, morbidity and mortality may be preventable – leaving room for improvement.2,3 Hence, the need for reliable measurement of healthcare quality is generally accepted, and increasingly promoted.4,5 However, there is no gold standard or established set of quality indicators (QI) to date for measuring the quality and safety of care,1 and to assess quality and safety at the level of institutions by prospectively collecting data about every individual patient.

The Project

Nonetheless, many indicators have been developed and some have even been validated in order to measure specific aspects of quality and safety.1,5 The established practical work of individuals and organisations are an invaluable resource for future steps to develop more comprehensive groups of indicators that better describe quality and safety of perioperative care.

With the EQUIP initiative, the ESA PSQC seeks to contribute to the search for a meaningful set of quality indicators for anaesthesiology and perioperative medicine. The project aims to provide an overview of quality and safety indicators that are currently used in anaesthesiology across Europe. This initiative has been presented to the meeting of the representatives of National Anaesthesiologists’ Societies (NAS) during Euroanaesthesia 2016 in London. Representatives of European NAS are surveyed and asked if their Society provides a set of QI and a quality data collection system to its members. The survey further asks for a detailed description of such indicators, and whether collection of quality data is mandatory for anaesthesiologists in the respective country.


The results of this survey will help to determine the current state of use of perioperative QI promoted by NAS, and help identify differences across Europe and areas of care that are not well described by QI so far. QI used in clinical practice can be compared by validated QI reported in the literature, and ideally a more comprehensive set of QI may be determined that allows a more accurate assessment of perioperative quality and safety.


1. Haller G, Stoelwinder J, Myles PS, McNeil J. Quality and safety indicators in anesthesia: a systematic review. Anesthesiology. 2009;110(5):1158-1175.
2. James JT. A new, evidence-based estimate of patient harms associated with hospital care. Journal of patient safety. 2013;9(3):122-128.
3. Landrigan CP, Parry GJ, Bones CB, Hackbarth AD, Goldmann DA, Sharek PJ. Temporal trends in rates of patient harm resulting from medical care. The New England journal of medicine. 2010;363(22):2124-2134.
4. Krause TR, Bell Kj Fau - Pronovost P, Pronovost P Fau - Etchegaray JM, Etchegaray JM. Measurement as a Performance Driver: The Case for a National Measurement System to Improve Patient Safety. LID - 10.1097/PTS.0000000000000315 [doi]. Journal of patient safety. 2017(1549-8425 (Electronic)).
5. Emond YE, Stienen JJ, Wollersheim HC, et al. Development and measurement of perioperative patient safety indicators. Br J Anaesth. 2015;114(6):963-972.