ii150 European Journal of Public Health, Volume 33 Supplement 2, 2023
journey. Based on a previous systematic review of guidelines
and an international expert panel review, we transformed
recommendations into standards through an iterative and
consensus qualitative approach. First, recommendations were
classified according to the perioperative period (pre, intra or
post) and based on predefined clinical areas. Second, one or
more recommendations were transformed into one standard.
Third, for each standard, measurable elements were developed
to highlight in practical terms what needs to be implemented
and measured, and the source of information and responsible
stakeholder were identified. The overall transformation was
performed by independent reviewers and the list of measurable
standards was approved and finalized through discussion.
From an initial list of 101 prioritized clinical practices
recommendations, we developed 103 standards with 164
measurable elements. The standards with the related measur-
able elements, classified based on the perioperative period,
were grouped in 12 different areas based on specific topic (e.g.,
complications preventions). Overall, these measurable stan-
dards can enhance dissemination and implementation of
patient safety standardized practices in the continuum of care
for adults’ patients undergoing surgery.
Abstract citation ID: ckad160.380
Development of a Core Outcome Set for Patient
Safety in Perioperative Care: Insights from the
SAFEST Project
Ana Beatriz Nunes
AB Nunes1
1
National School of Public Health, NOVA University, Lisbon, Portugal
Contact: ana.nunes@ensp.unl.pt
6.H. Round table: How can the public health
community contribute to better alcohol policies
through trade law?
Abstract citation ID: ckad160.381
Organised by: EUPHA-LAW, EUPHA-GH, EUPHA-FN, WHO/Europe,
Essex University (UK), Liverpool University (UK), Eurocare (Belgium),
Maynooth University (Ireland)
Chair persons: Sheila Gilheany (Ireland)
Contact: nikhil.gokani@essex.ac.uk
Alcohol is a causal factor in more than 200 disorders,
communicable and injuries. Harms results at even relatively
low levels of consumption, and it is estimated that alcohol use
causes 3 million deaths globally each year. In parallel to the
ever-growing evidence on alcohol-related harm, evidence also
continues to accumulate on the effectiveness of policy
interventions which tackle the commercial determinants of
alcohol consumption, not least on labelling, marketing, pricing
and availability. While it is imperative that States introduce
national measures to tackle alcohol harms, alcohol is not
merely an issue of national policy as it is manufactured,
marketed, bought and sold across borders. The WHO Global
Alcohol Strategy illustrates the importance of regulation in
contributing to the development of robust, comprehensive
interventions to tackle alcohol use. However, what States can
do at the national level is constrained by international rules. In
particular, international trade law under the World Trade
Organization is often invoked in opposing national rules. This
litigation can result in expensive, time-consuming and
distracting disputes with no certainty of winning. Even
before policies are challenged, ‘regulatory chill’ often results
in preventing, watering down and delaying policies. This is
Although surgical-related adverse effects are among the most
common in-hospital adverse events, no set of indicators has yet
been defined for a comprehensive and patient-centred analysis
of this phenomenon. Thus, it is crucial to standardise a
minimum set of indicators, a Core Outcome Set (COS), to
allow for monitoring and evaluation of implemented patient
safety best practices in perioperative care. The SAFEST project
aimed to develop a relevant and feasible COS for patient safety
in perioperative care, including patient-relevant data.
Following a multimethod approach, an initial list of indicators
(ILO) was developed by conducting an umbrella review on
patient safety in perioperative care in surgical adult patients.
The ILO was prioritised by a diverse group of experts,
including patients, through a two-round eDelphi Technique,
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according to the importance and feasibility of each indicator.
Exploring the challenges of measuring specific indicators, the
same experts will define the final list of indicators in a
consensus conference. From 588 indicators extracted in the
umbrella review, 247 indicators were included in the ILO to be
independently rated, on a 9-point Likert scale, by participating
experts. The indicators were grouped by the perioperative
period (preoperative, intraoperative, postoperative and mixed)
and further subgrouped by Donabedian’s quality of care
conceptual model Structure - Process - Outcome. During the
eDelphi process, some indicators were reworded, split, merged,
added or removed, according to experts’ comments. The final
set of indicators results is not yet available as this study is still
undergoing. This COS contributes to enhancing standardised
reporting in perioperative patient safety, allowing for bench-
marking across EU countries and facilitating data comparison
across studies.
unfortunate not least because many policies, if framed
correctly, could be defended successfully.
The objectives of this roundtable workshop are to:
1. To understand the relationship which trade law has with
national and regional alcohol policies.
2. To explore how various stakeholders can contribute to the
development rules which are not constrained by international
trade law.
Five short 5-minute presentations will be mixed with
discussions. The first presentation sets the scene through
giving an overview of the existing developments of alcohol
policies in Europe and the context States find themselves in.
The second presentation explores the role of WHO and the
work it is undertaking, as well as the interventions envisaged
by the WHO Global strategy, Global action plan and the
European framework. The third presentation will discuss the
various policies which have been discussed in international
trade law forums by States, and the roles some States have
played in promoting or challenging proposals by other States.
The fourth presentation will continue the discussions on trade
law by showing how policies can progress through increased
recognition on the right to know and efforts to grant this right
through standardising alcohol labelling internationally. The
fifth presentation will reflects on the work by civil society in
promoting more effective policies and the barriers faced from
the alcohol industry in particular. The workshop will be
moderated by the chair, who will draw on links and common
themes and facilitate discussions between panellists, and

between the panel and members of the public health
community in the audience.
Key messages:
 Trade law has a significant impact on national alcohol
policies.
 Trade law barriers can be overcome through effective
strategies.
Abstract citation ID: ckad160.382
Setting the scene on alcohol policies in Europe
Oliver Bartlett
O Bartlett1
1
Law School, Maynooth University, Dublin, Ireland
Contact: Ollie.Bartlett@mu.ie
The first presentation sets the scene through giving an
overview of the existing developments of alcohol policies in
Europe and the context States find themselves in.
Abstract citation ID: ckad160.383
The role of WHO in alcohol control
Carina Ferreira-Borges
C Ferreira-Borges1
1
WHO/Europe, Copenhagen, Denmark
Contact: ferreiraborgesc@who.int
The second presentation explores the role of WHO and the
work it is undertaking, as well as the interventions envisaged
by the WHO Global strategy, Global action plan and the
European framework.
6.I. Workshop: Assessing health system resilience
to future shocks: a new tool for policy making
Abstract citation ID: ckad160.387
Organised by: European Observatory on Health Systems and Policies,
Organisation for Economic Co-operation and Development, European
Commission
Chair persons: Steve Thomas (Ireland), Jonathan Cylus (UK)
Contact: zimmermannj@who.int
The COVID-19 pandemic has highlighted the importance of
health system resilience, the ability of a health system to
prepare for, manage and learn from a shock. Other recent
adverse events, such as economic crises, conflict, migration
and extreme weather have demonstrated how a wide range of
shocks can challenge health systems. Health systems vary in
their ability to respond to shocks and other challenges,
mitigate adverse impacts, and learn from previous experience.
While emergency preparedness and planning is a well
established component of health system governance in many
countries, no methodology currently exists to systematically
test the resilience of a health system to a broad range of shocks.
In this workshop, the European Observatory on Health
Systems and Policies (OBS) and the Organization for
Economic Cooperation and Development (OECD) share
learnings from an ongoing project with the European
Commission (EC) to help EU Member States assess and
understand the resilience of their health system to a wide range
of future shocks. The resilience testing methodology draws on
two conceptual frameworks: the Health System Performance
Assessment Framework for Universal Health Coverage (HSPA
16th European Public Health Conference 2023 ii151
Abstract citation ID: ckad160.384
States’ action in international trade
Amandine Garde
A Garde1
1
School of Law and Social Justice, University of Liverpool, Liverpool, UK
Contact: amandine.garde@liverpool.ac.uk
The third presentation will discuss the various policies which
have been discussed in international trade law forums by
States, and the roles some States have played in promoting or
challenging proposals by other States.
Abstract citation ID: ckad160.385
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Policy progress through the right to know and
standardisation of alcohol labelling
Nikhil Gokani
N Gokani1
1
Law School, University of Essex, Colchester, UK
Contact: nikhil.gokani@essex.ac.uk
The fourth presentation will continue the discussions on trade
law by showing how policies can progress through increased
recognition on the right to know and efforts to grant this right
through standardising alcohol labelling internationally.
Abstract citation ID: ckad160.386
The role of civil society in promoting effective policies
F Berteletti1
1
Eurocare, Brussel, Belgium
Contact: florence.berteletti@eurocare.org
The fifth presentation will reflects on the work by civil society
in promoting more effective policies and the barriers faced
from the alcohol industry in particular.
Framework for UHC) and the Shock Cycle. A specific shock
scenario is chosen from a broad range of possible shocks to
hypothetically challenge a given health system to its limits. This
highlights key structural strengths and weaknesses of the health
system. The country-led process culminates in a resilience test
workshop that brings together policy makers, civil servants and
other relevant experts. The test day is supported by an expert
facilitator and research team, who provide background
knowledge and structure the test day. Results of the resilience
test include an understanding of the health system strengths
and vulnerabilities specific to the shock. The test day may also
anticipate spill-overs effects to other health system functions,
and contribute towards a participatory approach to improve
preparedness going forward.
The objectives of the workshop are to:
- present the new methodology for resilience testing;
- showcase country examples that have piloted the
methodology;
- engage workshop participants in discussion towards a
common approach to health system resilience strengthening.
The workshop consists of presentations (40 minutes) and
audience interaction (20 minutes). The presentations will cover
the methodology, pilot countries’ experience, and an EU view
of the resilience testing process. The audience interaction will
consist of moderated discussion with an element of a digital
feedback and Q&A (if settings allow). Discussion will reflect on
usability, potential adaptations to suit various national