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ORIGINAL ARTICLE Free access
Minerva Anestesiologica 2020 December;86(12):1305-20
DOI: 10.23736/S0375-9393.20.14112-9
Copyright © 2020 EDIZIONI MINERVA MEDICA
language: English
PROSAFE: a European endeavor to improve quality of critical care medicine in seven countries
Stefano FINAZZI 1, Giulia PACI 1, Luca ANTIGA 2, Obou BRISSY 1, Greta CARRARA 1, Daniele CRESPI 1, Gabor CSATO 3, Akos CSOMOS 4, Or DUEK 5, Sara FACCHINETTI 6, Joanne FLEMING 1, Elena GARBERO 1 ✉, Massimo GIANNI 7, Primoz GRADISEK 8, Rafael KAPS 9, Theodoros KYPRIANOU 10, Isaac LAZAR 5, Malgorzata MIKASZEWSKA-SOKOLEWICZ 11, Matteo MONDINI 1, Giovanni NATTINO 1, 12, Carlo OLIVIERI 13, Daniele POOLE 14, Claudio PREVITALI 1, Danilo RADRIZZANI 15, Carlotta ROSSI 1, Stefano SKURZAK 16, Mario TAVOLA 17, Nektaria XIROUCHAKI 18, Guido BERTOLINI 1 GiViTI-PROSAFE collaboration 
1 GiViTI Coordinating Center, Institute for Pharmacological Research Mario Negri IRCCS, Clinical Research Center for Rare Diseases Aldo and Cele Daccò, Ranica, Bergamo, Italy; 2 Orobix, Bergamo, Italy; 3 Semmelweis University, Budapest, Hungary; 4 Hungarian Army Medical Center, Budapest, Hungary; 5 Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; 6 Infocert S.p.A., Rome, Italy; 7 Department of Anesthesiology and Intensive Care, Regional Valle d’Aosta Hospital, Aosta, Italy; 8 University Medical Center, Ljubljana, Slovenia; 9 General Hospital Novo Mesto, Novo Mesto, Slovenia; 10 Nicosia General Hospital, University of Nicosia, Nicosia, Cyprus; 11 Department of Anesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland; 12 Division of Biostatistics, The Ohio State University, Columbus, OH, USA; 13 Department of Anesthesiology and Intensive Care, ASL Vercelli, Vercelli, Italy; 14 Department of Anesthesiology and Intensive Care, San Martino Hospital, Belluno, Italy; 15 Department of Anesthesiology and Intensive Care, Hospital of Legnano, Legnano, Milan, Italy; 16 Department of Anesthesiology and Intensive Care, San Giovanni Battista Hospital, Turin, Italy; 17 Department of Anesthesiology and Intensive Care, ASST Lecco, Lecco, Italy; 18 University Hospital of Heraklion, Crete, Greece
BACKGROUND: Long-lasting shared research databases are an important source of epidemiological information and can promote comparison between different healthcare services. Here we present PROSAFE, an advanced international research network in intensive care medicine, with the focus on assessing and improving the quality of care. The project involved 343 ICUs in seven countries. All patients admitted to the ICU were eligible for data collection.
METHODS: The PROSAFE network collected data using the same electronic case report form translated into the corresponding languages. A complex, multidimensional validation system was implemented to ensure maximum data quality. Individual and aggregate reports by country, region, and ICU type were prepared annually. A web-based data-sharing system allowed participants to autonomously perform different analyses on both own data and the entire database.
RESULTS: The final analysis was restricted to 262 general ICUs and 432,223 adult patients, mostly admitted to Italian units, where a research network had been active since 1991. Organization of critical care medicine in the seven countries was relatively similar, in terms of staffing, case mix and procedures, suggesting a common understanding of the role of critical care medicine. Conversely, ICU equipment differed, and patient outcomes showed wide variations among countries.
CONCLUSIONS: PROSAFE is a permanent, stable, open access, multilingual database for clinical benchmarking, ICU self-evaluation and research within and across countries, which offers a unique opportunity to improve the quality of critical care. Its entry into routine clinical practice on a voluntary basis is testimony to the success and viability of the endeavor.
KEY WORDS: Quality of health care; Intensive care units; Research design
