Welcome to the Improving Patient Outcomes (ImPrOve) Initiative!

A European Think Tank working to address and propose solutions for an important public health issue – serious complication rates in the 30 days after high-risk surgery remain high.

We aim to improve awareness, monitoring, and management of haemodynamic instability, particularly intraoperative hypotension which refers to the lowering of blood pressure during surgery.

Only by bringing experts and stakeholders together can we improve patient safety, outcomes and become a force for change.

About ImPrOve

The ImPrOve Think Tank is a multidisciplinary pan-European group of anaesthetists, surgeons and patient representatives. We advocate for European and national action to ensure that intraoperative hypotension (IOH) is effectively managed and prevented, through the use of innovative digital monitoring to improve perioperative outcomes, reduce complications, shorten hospital lengths-of-stay, avoid rehospitalisation, and optimise costs.

The challenge

Death and serious complication rates in the 30-days after high-risk surgery remain high across Europe.1 A key contributing factor and a growing threat to patient safety is haemodynamic instability, manifested as drops in blood pressure and known as intraoperative hypotension (IOH).2,3 IOH is strongly linked to several severe postoperative complications, including kidney and heart injury.4

Despite the danger of IOH, it is poorly understood or recognised. However, if IOH is effectively monitored and managed in the operating room and during recovery, the risk of life-changing postoperative complications can be significantly reduced or avoided.5,6

Our vision and mission

We work to enhance patient safety and outcomes; improve awareness, and to monitor and manage haemodynamic instability manifested as IOH.

In doing so, it is likely that many deaths and severe complications after high-risk surgery in Europe can be prevented.

Our Focus

IOH/hemodynamic instability

While there are many challenges in high-risk surgery, the most alarming complication for the ImPrOve Think Tank is haemodynamic instability, manifested as drops in blood pressure, and known as intraoperative hypotension.

During high-risk surgery it is vital that blood continues to flow to organs. If blood pressure drops, and organs don’t get enough blood, the higher the risk of severe postoperative complications, such as myocardial injury, acute kidney injury, and increased mortality.4 These drops in blood pressure are known as intraoperative hypotension (IOH) and are common during surgery under general anaesthesia, occurring in up to 99% of patients.2

It has the potential to cause tissue damage in any vital organ, but the heart and kidneys are most affected. Recent studies show associations between IOH and increased risk of acute kidney injury (AKI) and myocardial injury – the leading cause of post-operative mortality.4 Postsurgical patients with AKI and myocardial injury stay longer in hospital, have higher readmission rates, and cost more to care for, placing a strain on European healthcare systems.7

By 2050, it is predicted that 1 in 4 people could be over 65.8 This brings a myriad of potential health challenges for surgeons and anaesthetists – particularly with haemodynamic instability reported as high as 83% in more senior patients.9 With rates so elevated, the ImPrOve Think Tank believe haemodynamic instability to be a likely cause of a significant proportion of modifiable postoperative mortality and morbidity in Europe.

Image sourced and designed using resources from Freepik.com.

What to ImPrOve

The good news is that the burden of haemodynamic instability, manifested as drops in blood pressure, and known as intraoperative hypotension (IOH) can be reduced. If effectively monitored and prevented, these complications can be avoided, and patient outcomes can be significantly improved.

The ImPrOve Think Tank defined what actions are needed to make meaningful change to patient safety and outcomes for each key stakeholder:

The ImPrOve Think Tank recommends that healthcare systems and clinicians improve:

Research and funding to understand the pathophysiology of haemodynamic instability and individualising blood pressure targets

Education on and awareness of haemodynamic instability and its strong association with poor patient outcomes

Communicating the risk of surgery to patients and informing them of any complications observed during their procedure

Evaluating novel technologies and therapies to effectively monitor, manage and mitigate haemodynamic instability

Availability of appropriately staffed and equipped postoperative beds and long-term monitoring

High-risk patient safety and outcomes in line with other established patient safety organisations and movements

Further, the ImPrOve Think Tank defined its calls-to-action for each stakeholder – clinicians, policy makers and patients – to make meaningful change to patient safety and outcomes (a more detailed breakdown of each stakeholder’s role in the calls-to-action can be found under useful resources).

ImPrOve calls-to-action

The ImPrOve Think Tank defined its calls-to-action for each stakeholder – clinicians, policy makers and patients – to make meaningful change to patient safety and outcomes


Ensure adherence to and implementation of new European guidelines on blood circulation during surgery by improving training for clinicians.


Secure new sources of funding for hospitals to invest in innovative digital monitoring technologies, such as advanced haemodynamic monitoring, to maintain stable blood circulation during surgery.

Policy makers

Recognise in health data policies the value of patient safety data generated by innovative digital monitoring technologies.

Policy makers

Involve patients in a dialogue about the risks of poor blood circulation so they are invested in the actions taken to ensure the best outcomes and safety before, during and after surgery.

Clinicians Patients

Fundamentally, these solutions, supported by advanced haemodynamic monitoring technology, intend to reduce the risk of haemodynamic instability and improve patient safety and outcomes after high-risk surgery.

To learn more, please click here for the full European Report Improving patient safety - why perioperative care and effective monitoring matters.


European Report

Click below to read our European Report. This report goes into detail about our mission, and why haemodynamic instability is such a cause for concern. We also use this report to outline our solutions to this problem, and how clinicians, patients and policy makers can work together to ensure patient safety and outcomes are optimised throughout Europe.

Read the English version Read the Italian version Read the Spanish version


Provides you with some extra background to help you understand what intraoperative hypotension (IOH) is, why it is important, the causes and impact of IOH, and how this can be managed.


Launch Webinar summary

Watch an expert-led discussion on improving patient safety and outcomes and why perioperative care and effective monitoring matters. With this report, ImPrOve is calling for the effective monitoring and prevention of haemodynamic instability such as IOH. This can be achieved through improved education and awareness, evaluating novel technologies and increasing funding to support training and long-term monitoring solutions. To see the full webinar click below, or watch the highlights video above.

Watch Full Length Launch Webinar

The ImPrOve Think Tank operate as an independent entity made up of multi-stakeholders who believe patient safety is paramount. We are currently supported by funding from Edwards Lifesciences.

Contact us

If you would like to be kept in touch of news and advancements from the ImPrOve Think Tank please confirm the following details:

Thank you for registering your interest in the ImPrOve Think Tank. Let’s become a European force for change together.

For more information, please contact:
ImPrOve Secretariat


1. International Surgical Outcomes Study group. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. Br J Anaesth. 2016; Oct 31;117(5):601-609. Available at: https://pubmed.ncbi.nlm.nih.gov/27799174/ [accessed December 2020]. 2. Bijker JB, van Klei WA, Kappen TH, van Wolfswinkel L, Moons, KGM, Kalkman, CJ. Incidence of Intraoperative Hypotension as a Function of the Chosen Definition. Anesthesiology. 2007; Aug;107(2):213-20. Available at: https://pubs.asahqorg/anesthesiology/article/107/2/213/7525/Incidence-of-IntraoperativeHypotension-as-a [accessed December 2020]. 3. Wesselink EM, Kappen TH, Torn HM, Slooter AJC, van Klei WA. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Br J Anaesth. 2018 Oct;121(4):706-721. Available at: https://bjanaesthesia.org/article/S0007-0912(18)30376-3/fulltext [accessed December 2020]. 4. Sessler DI, Bloomstone JA, Aronson S, Berry C, Gan TJ, Kellum JA et al. Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery. Br J Anaesth. 2019, May;122(5):563-574. Available at: https://bjanaesthesia.org/article/S0007-0912(19)30050-9/fulltext [accessed December 2020]. 5. Royal College of Surgeons of England. Who’s Who in the Surgical Team. Available at: https://www.rcseng.ac.uk/patient-care/surgical-staff-and-regulation/whos-who-in-the-surgical-team/ [accessed January 2021]. 6. Watson X and Cecconi M. Haemodynamic monitoring in the peri-operative period: the past, the present and the future. Anaesthesia. 2017 Jan;72 Suppl 1:7-15. Available at: https://associationofanaesthetistspublications.onlinelibrary.wiley.com/doi/epdf/10.1111/anae.13737 [accessed February 2021]. 7. Keuffel EL, Rizzo J, Stevens M, Gunnarsson C, Maheshwari K. Hospital costs associated with intraoperative hypotension among non-cardiac surgical patients in the US: a simulation model. J Med Econ. 2019 Jul;22(7):645-651. Available at: https://www.tandfonline.com/doi/full/10.1080/13696998.2019.1591147 [accessed February 2021]. 8. United Nations. Ageing. 2019. Available at: https://www.un.org/en/sections/issues-depth/ageing/ [accessed December 2020]. 9. Wickham A, Highton D, Martin D, The Pan London Perioperative Audit and Research Network. Care of elderly patients: a prospective audit of the prevalence of hypotension and the use of BIS intraoperatively in 25 hospitals in London. Perioper Med (Lond). 2016; 5: 12. Available at: (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4882849/) [accessed December 2020].