INTRODUCTION: Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU), with surgical adverse events being the most common types reported. AIM: SAFEST project aims to enhance perioperative care quality and patient safety by establishing and implementing widely supported evidence-based perioperative patient safety practices to reduce surgical adverse events. METHODS: We will conduct a mixed-methods hybrid type III implementation study supporting the development and adoption of evidence-based practices through a Quality Improvement Learning Collaborative (QILC) in co-creation with stakeholders. The project will be conducted in 10 hospitals and related healthcare facilities of 5 European countries. We will assess the level of adherence to the standardised practices, as well as surgical complications incidence, patient-reported outcomes, contextual factors influencing the implementation of the patient safety practices, and sustainability. The project will consist of six components: 1) Development of patient safety standardised practices in perioperative care; 2) Guided self-evaluation of the standardised practices; 3) Identification of priorities and actions plans; 4) Implementation of a QILC strategy; 5) Evaluation of the strategy effectiveness; 6) Patient empowerment for patient safety. Sustainability of the project will be ensured by systematic assessment of sustainability factors and business plans. Towards the end of the project, a call for participation will be launched to allow other hospitals to conduct the self-evaluation of the standardized practices. DISCUSSION: The SAFEST project will promote patient safety standardized practices in the continuum of care for adult patients undergoing surgery. This project will result in a broad implementation of evidence-based practices for perioperative care, spanning from the care provided before hospital admission to post-operative recovery at home or outpatient facilities. Different implementation challenges will be faced in the application of the evidence-based practices, which will be mitigated by developing context-specific implementation strategies. Results will be disseminated in peer-reviewed publications and will be available in an online platform.

Avedis Donabedian Research Institute Barcelona Spain

Department of Epidemiology Instituto Nacional de Saúde Doutor Ricardo Jorge Lisboa Portugal

Department of Internal Medicine Institute of Clinical Medicine University of Tartu Tartu Estonia

Department of Operating Theatres Radboud University Medical Center Nijmegen The Netherlands

Department of Public Health Charles University 3rd Faculty of Medicine Prague Czech Republic

Department of Surgery Institute of Clinical Medicine University of Tartu Tartu Estonia

Department of Surgery North Estonia Medical Centre Tallinn Estonia

Department of Surgery Northwestern Quality Improvement Research and Education in Surgery Northwestern University Chicago IL United States of America

European Hospital and Healthcare Federation Brussels Belgium

European Society of Anaesthesiology and Intensive Care Brussels Belgium

Faculty of Management Economics and Society University of Witten Herdecke Witten Germany

Netherlands Institute for Health Services Research Utrecht The Netherlands

Network for Research on Chronicity Primary Care and Health Promotion Barcelona Spain

NOVA National School of Public Health Public Health Research Center Comprehensive Health Research Center CHRC NOVA University Lisbon Lisbon Portugal

OptiMedis AG Hamburg Germany

Scientific Center for Quality of Healthcare Radboud University Medical Center Nijmegen The Netherlands

Spanish Anaesthesia and Reanimation Incident Reporting System Alcorcon Spain

Spojená Akreditační Komise Czech accreditation commission Prague Czech Republic

Universidad Autónoma de Barcelona Barcelona Spain

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