Evidence-based organization and patient safety strategies in European hospitals

Rosa Sunol*, Cordula Wagner, Onyebuchi A. Arah, Charles D. Shaw, Solvejg Kristensen, Caroline A. Thompson, Maral Dersarkissian, Paul D. Bartels, Holger Pfaff, Mariona Secanell, Nuria Mora, Frantisek Vlcek, Halina Kutaj-Wasikowska, Basia Kutryba, Philippe Michel, Oliver Groene, N. Klazinga, D. S. Kringos, M. J M H Lombarts, T. PlochgM. A. Lopez, P. Vallejo, F. Saillour-Glenisson, M. Car, S. Jones, E. Klaus, S. Bottaro, P. Garel, M. Saluvan, C. Bruneau, A. Depaigne-Loth, A. Hammer, O. Ommen, D. Botje, A. Escoval, A. Lívio, M. Eiras, M. Franca, I. Leite, F. Almeman, H. Kus, K. Ozturk, R. Mannion, A. Wang, A. Thompson, DUQuE Project Consortium

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Citations (Scopus)


Objective: To explore how European hospitals have implemented patient safety strategies (PSS) and evidence-based organization of care pathway (EBOP) recommendations and examine the extent to which implementation varies between countries and hospitals. Design: Mixed-method multilevel cross-sectional design in seven countries as part of the European Union-funded project 'Deepening our Understanding of Quality improvement in Europe' (DUQuE). Setting and participants: Seventy-four acute care hospitals with 292 departments managing acute myocardial infarction (AMI), hip fracture, stroke, and obstetric deliveries. Main outcome measure: Five multi-item composite measures-one generic measure for PSS and four pathway-specific measures for EBOP. Results: Potassium chloride had only been removed from general medication stocks in 9.4-30.5% of different pathways wards and patients were adequately identified with wristband in 43.0-59.7%. Although 86.3% of areas treating AMI patients had immediate access to a specialist physician, only 56.0% had arrangements for patients to receive thrombolysis within 30 min of arrival at the hospital. A substantial amount of the total variance observed was due to between-hospital differences in the same country for PSS (65.9%). In EBOP, between-country differences play also an important role (10.1% in AMI to 57.1% in hip fracture). Conclusions: There were substantial gaps between evidence and practice of PSS and EBOP in a sample of European hospitals and variations due to country differences are more important in EBOP than in PSS, but less important than within-country variations. Agencies supporting the implementation of PSS and EBOP should closely re-examine the effectiveness of their current strategies.

Original languageEnglish
Pages (from-to)47-55
Number of pages9
JournalInternational Journal for Quality in Health Care
Publication statusPublished - Apr 2014
Externally publishedYes


  • Appropriate healthcare
  • Effectiveness
  • Hospital care
  • Patient safety
  • Practice variations
  • Quality improvement
  • Quality management


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