ICU Management & Practice, ICU Volume 13 - Issue 2 - Summer 2013

Implementing the Helsinki Declaration on Safety in Anesthesiology in Europe

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Sven Staender, MD


Department of Anaesthesia & Intensive Care

Regional Hospital Maennedorf, Switzerland

[email protected]


Sven Staender (Chairman), on behalf of the EBA/ESA Task Force Patient Safety (Andrew Smith, Guttorm Brattebø, David Whitaker)


The ESA Patient Safety Starter Kit was launched in June at Euroanaesthesia 2013. This article describes the background to the kit and its development. In addition the work of the ESA’s Task Force Patient Safety is described and its strategy for implementing the Helsinki Declaration on Patient Safety in Anaesthesiology.


In June 2010 the European Board of Anaesthesiology (EBA), the European Society of Anaesthesiology (ESA) and the National Anaesthesia Societies Committee (NASC) launched the Helsinki Declaration on Patient Safety in Anaesthesiology (Mellin-Olsen et al. 2010). The aims are simple, ambitious and powerful, and represent a shared European opinion about what is worth doing and practical to improve patient safety in anaesthesiology. The declaration recommends practical steps that all anaesthesiologists as well as national anaesthesia societies should adapt for their own practice.


After the initial signing of the Helsinki Declaration by the ESA member state societies the declaration has been signed by industry representatives and patient organisations. Over the last three years, its existence has spread around the world. To date the Helsinki Declaration has been signed or adopted by a variety of countries and societies worldwide, including Latin American countries, Canada, Australia, New Zealand, the United Arab Emirates and the Confederation of the ASEAN Societies of Anesthesiologists, representing Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam. In addition the Declaration has been signed by hundreds of anaesthetists around the world.


ESA and EBA set up a Task Force Patient Safety in order to help distribute the aims of that Declaration. This Task Force consists of four anaesthetists, two representing the EBA (David Whitaker and Guttorm Brattebø) and two representing the ESA (Andrew Smith and Sven Staender). The aims of the Task Force were to create knowledge and resources for patient safety in order to help implement the Helsinki Declaration. A wide variety of activities has been completed by the Task Force over the last three years.


Among them are:

• The template for a Departmental Safety report;

• A drug syringe labelling study (with the Universities of Geneva and Berlin) (Wickboldt et al. 2012);

• A book on patient safety in anaesthesia distributed to every participant of the Euroanaesthesia congress 2011 (Best Practice and Research Clinical Anaesthesiology – Hugo Van Aken, Editor: Elsevier Science, 2011) (van Aken et al. 2011);

• A survey on the use of capnography in Europe (presented at Euroanaesthesia 2012);

• A survey on adherence to core contents of the Helsinki Declaration (presented at Euroanaesthesia 2013) and;

• Crisis checklists that should help to manage critical situations in the perioperative setting. These crisis checklists have been developed together with David Borshoff from Perth, Australia, author of The Anaesthetic Crisis Manual, which contains similar checklists as well as accompanying explanations (Borshoff 2011).


After compiling the first draft of these checklists a modified Delphi process was started and the content was sent for comment by invited and experienced anaesthesiologists in Europe. The final draft of these checklists was put up for comment on the members’ part of the webpage of ESA. These checklists are a compilation of European approaches to various crisis situations in the perioperative setting. Use of such checklists has been proven to be beneficial in a recent study where the authors found that failure to adhere to lifesaving processes of care was less common during simulations when checklists were available and the team performed better when the crisis checklists were available than when they were not (Arriaga et al. 2013).


The Patient Safety Kit

This content has now been compiled in a starter kit, which was distributed at Euroanaesthesia 2013. To cater for the multiple aims of the Helsinki Declaration, the safety starter kit contains the following:

• Selected Articles of the publication “Safety in Anaesthesia” (Best Practice and Research Clinical Anaesthesiology);

• An online basic guide on Patient Safety by Charles Vincent (Vincent 2012);

• A proposed template for an anaesthesia departmental safety report;

• The text of the original Helsinki Declaration;

• Hazard warnings published in countries that alert anaesthesiologists to important adverse events (examples from the UK, Germany and Switzerland);

• Powerpoint presentations plus audio podcasts of essential aspects of patient safety; Topics covered include human limitations in the operating room, introduction to critical incident reporting etc.;

• Powerpoint presentations of WHO (WHO 2013) and ESA for basic lectures on patient safety / risk management, including topics such as medication error, good communication and team work, simulation, engaging with patients and carers, and understanding clinical risk;

• Checklists for emergency management in the operating room, for situations such as those involving newborns, anaphylaxis, hypertension, hypotension etc.;

• The WHO Safe Surgery Checklist; and

• A list of links to important Internet resources.


The starter kit is a collection of necessary resources to help fulfill the aims of the Helsinki Declaration and to make it readily and easily available and useful for anaesthesiologists across Europe and worldwide.


Many of the practices and tools referred to in the starter kit may be commonplace in many hospitals in Europe. But ESA hopes that this starter kit will support hospitals, particularly those in countries that still have a long way to go before the standards of the Helsinki Declaration are fully established.


Next Steps

Following Euroanaesthesia 2013, the ESA will publish the kit in a dedicated section of its website (, and begin working on implementation of the Helsinki Declaration on a national level. This will be done in collaboration with the EBA, NASC, ESA and the individual national societies.


The survey on the European distribution of the content of the Helsinki Declaration performed by the Task Force

Patient Safety, and conducted among the representatives of the national anaesthesia societies (NASC) and the ESA council members, showed that only a few European countries today have implemented all of the content of the declaration. The broad implementation of the content of the Helsinki Declaration will be a major challenge for the future activities of EBA and ESA.


This starter kit will help to provide resources for all interested hospitals, departments of anaesthesiology and national societies. ESA will accompany this process of implementation with a strategy over the next years. This strategy has been worked out with various experienced anaesthesiologists from Europe and approved by the ESA board of directors. It will focus on three major aspects over the next years:

1.European coordination of activities and resources;

2.National distribution and implementation; and

3.Accreditation of national societies.


Table 1 (p. 31) shows the corresponding activities concerning communication and distribution and Table 2 (above) shows the required action on a European and national as well as hospital level.


What is now required is the support and work of all of us who care for patients every day in the perioperative setting to put the words of the Helsinki Declaration into practice.

Author Sven Staender, MD Professor Department of Anaesthesia & Intensive Care Regional Hospital Maennedorf, Switzerland [email protected]

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