Impact of a Quality Improvement Collaborative on Perioperative Patient Safety: an ITS Analysis

Unsafe surgical care is a major public health challenge in Europe, resulting in substantial avoidable morbidity. While Quality Improvement Collaboratives (QIC) are frequently used to bridge the evidence-practice gap, robust evidence of their effectiveness remains limited. This study evaluates the impact of a European QIC on adherence to Perioperative Patient Safety Practices (PPSP) and surgical complications. A quasi-experimental, multicentre interrupted time series study was conducted within the SAFEST project. Adult patients undergoing high-risk elective surgery in 10 hospitals across five European countries (June 2023–November 2025) were included. The intervention was a QIC supporting implementation of a standardized PPSP bundle. The primary outcome was adherence to PPSP; the secondary outcome was prevalence of surgical complications. Monthly aggregated data were analysed using segmented regression models, adjusted for seasonality and case-mix, to estimate immediate level changes and trends during the intervention. Provisional results are presented. A total of 4604 (pre-QIC) and 6957 (during-QIC) patient records were reviewed. Baseline PPSP adherence was 59.9%. Following QIC initiation, adherence increased immediately (+8.35%) but declined over time (−0.15 percentage points/month), indicating limited sustainability. Adherence varied across bundle components. Surgical complications decreased initially (22.1% to 19.2%; −13.12%), but this effect was not sustained and varied by complication type. This European multicountry perioperative QIC led to moderate immediate improvements in PPSP adherence and a reduction in complications. However, the lack of sustained effects and variability across components highlights the influence of contextual factors, implementation fidelity, and pathway complexity. Achieving long-term, sustained improvements in PPSP bundle adherence and surgical outcomes may require more resource-intensive implementation strategies.

Key messages

• This European QIC improved perioperative safety adherence and outcomes in the short term, but sustaining gains across hospitals remained challenging.

• Long-term perioperative safety requires resource-intensive, culturally adapted implementation strategies.