Non-clinical interventions to improve patient safety in the perioperative care process: An umbrella review

BACKGROUND: Perioperative care is associated with a substantial risk of preventable harm, yet evidence on effective non-clinical safety strategies remain fragmented. This umbrella review, conducted within the framework of the European SAFEST project, aims to synthesise evidence of non-clinical interventions to improve patient safety in adult perioperative care. METHODS: PubMed, Scopus, PsycINFO, CINAHL, and the Cochrane Library were searched for systematic reviews and meta-analyses published between January 2012 and April 2025. Eligible reviews included studies meeting Cochrane Effective Practice and Organisation of Care (EPOC) criteria. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist, and findings were synthesised narratively. RESULTS: One hundred systematic reviews were included. Most interventions targeted patients (n=55) and included integrative medicine and strategies for preoperative preparation and education. Forty-one reviews evaluated coordinated perioperative care programmes, mainly Enhanced Recovery After Surgery (ERAS); three evaluated surgical safety checklists and one evaluated simulation training for healthcare professionals. Ninety reviews reported improvement in at least one patient safety outcome. Patient-targeted interventions were most consistently associated with reductions in pain and anxiety, while ERAS programmes and surgical safety checklists were associated with fewer complications, infections, mortality, and shorter hospital stay. Methodological quality was generally moderate to high, however, GRADE was reported in only 23 reviews and most commonly indicated low-to-moderate certainty of evidence. CONCLUSION: Non-clinical interventions have the potential to improve perioperative patient safety. However, confidence in many findings is limited by substantial heterogeneity and predominantly low-to-moderate certainty of evidence. More rigorous research, standardised outcome reporting, and greater attention to healthcare professional-targeted and intraoperative interventions are needed.