title: Evidence-based organization and patient safety strategies in European hospitals.
abstract: 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.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
authors.affiliation: Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, C/Provenza 293 pral, 08037 Barcelona, Spain. rsunol@fadq.org; fad@fadq.org.
authors.forename: Rosa
authors.initials: R
authors.lastname: Sunol
authors.forename: Cordula
authors.initials: C
authors.lastname: Wagner
authors.forename: Onyebuchi A
authors.initials: OA
authors.lastname: Arah
authors.forename: Charles D
authors.initials: CD
authors.lastname: Shaw
authors.forename: Solvejg
authors.initials: S
authors.lastname: Kristensen
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Thompson
authors.forename: Maral
authors.initials: M
authors.lastname: Dersarkissian
authors.forename: Paul D
authors.initials: PD
authors.lastname: Bartels
authors.forename: Holger
authors.initials: H
authors.lastname: Pfaff
authors.forename: Mariona
authors.initials: M
authors.lastname: Secanell
authors.forename: Nuria
authors.initials: N
authors.lastname: Mora
authors.forename: Frantisek
authors.initials: F
authors.lastname: Vlcek
authors.forename: Halina
authors.initials: H
authors.lastname: Kutaj-Wasikowska
authors.forename: Basia
authors.initials: B
authors.lastname: Kutryba
authors.forename: Philippe
authors.initials: P
authors.lastname: Michel
authors.forename: Oliver
authors.initials: O
authors.lastname: Groene
mesh_terms: D000704:Analysis of Variance; D005062:European Union; D055317:Evidence-Based Practice; D019983:Guideline Adherence; D006761:Hospitals / Q000592:standards*; D006801:Humans; D017063:Outcome Assessment, Health Care; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration; D017751:Safety Management / Q000379:methods*
keywords: appropriate healthcare; effectiveness; hospital care; patient safety; practice variations; quality improvement; quality management