Intensive Care Units (ICUs) represent one of the most complex, resource intensive and high-risk environments in modern healthcare. Patients admitted to ICUs typically experience life-threatening conditions requiring continuous monitoring, advanced life-support technologies, and rapid clinical decision-making. Care is delivered by multidisciplinary teams operating in high-pressure settings where breakdowns in communication, coordination, or system processes can quickly lead to adverse events (Fan et al., 2026). Consequently, patient safety is a central priority in intensive care practice, and improving safety in ICUs has become a key focus of clinical guidelines, health policy and quality improvement initiatives worldwide under the Sustainable Development Goals paradigm/ model. Recent studies continue to emphasize that the complexity of ICU care and the intensity of clinical interventions increase the risk of medical errors and safety incidents if organizational and team-based safeguards are not effectively implemented (Caccioppola et al., 2026). In many European healthcare contexts, ICU care is provided within publicly financed, insurance-based, or mixed systems, where regulatory and professional frameworks typically emphasise patient rights, quality improvement, and accountability in care delivery. European healthcare systems increasingly promote patient safety through national and transnational governance frameworks, regulatory oversight, and professional standards. However, despite this strong policy emphasis, the concept of a “Safe ICU” is rarely explicitly defined in the scientific or policy literature. Instead, safety in intensive care is often inferred from individual indicators, such as rates of adverse events, healthcare-associated infections, medication errors, staffing ratios, or compliance with clinical protocols and accreditation standards. While these indicators provide important information about specific dimensions of safety, they represent only partial perspectives on a much broader phenomenon (Yang et al., 2025). Evidence from recent European research highlights that ICU safety is strongly influenced by factors such as safety culture, communication practices, teamwork, leadership, and learning systems, which are not always captured by traditional outcome indicators (Laaksonen et al., 2025). Relying solely on outcome-based indicators risks reducing safety to measurable events or regulatory compliance rather than recognizing it as a dynamic and system-based property that emerges from interactions among healthcare professionals, patients, organizational structures, technologies, epidemiological factors/global emergencies and broader healthcare governance systems (Elmdni, 2025). Healthcare safety is widely conceptualised within safety science as a complex adaptive phenomenon influenced by interacting technical and non-technical factors, including leadership, team dynamics, situational awareness, and organisational learning processes (Underwood, 2024). In intensive care environments, these factors interact continuously within complex healthcare systems. Safety may depend not only on the absence of adverse events but also on the presence of resilient system characteristics, such as effective teamwork, open communication, continuous monitoring, and the capacity to anticipate and respond to emerging risks (Fan et al., 2026). Studies examining ICU safety culture across healthcare settings demonstrate that organizational conditions such as leadership support, interprofessional collaboration, and transparent reporting systems play a critical role in preventing errors and improving patient outcomes (Atashzadeh-Shoorideh et al., 2022; Malinowska-Lipień et al., 2024). Given the multidimensional nature of ICU safety, the absence of a clear conceptual definition that is consensual of safe ICU presents important challenges. Without conceptual clarity, safety initiatives may remain fragmented, measurement strategies may focus on limited indicators, and comparisons across healthcare systems may be difficult to interpret. This issue is particularly relevant in Europe, where cross-national collaboration in patient safety research and policy increasingly requires shared conceptual frameworks. Clarifying the concept of safe ICU is therefore necessary to support consistent understanding and application across clinical practice, research, education, and healthcare policy (Gunawan et al., 2023). A clearer conceptualization may help integrate diverse perspectives on ICU safety, linking outcome indicators with organizational and system-level factors that shape safe care delivery. Promoting safety has long been recognized as a fundamental objective of intensive care practice, and numerous frameworks, safety programs, and measurement initiatives have been developed to improve patient safety in critical care. Nevertheless, despite this extensive attention, the concept itself has not been comprehensively analyzed to determine its defining attributes, conceptual boundaries, and underlying structure. Advancing the theoretical development of ICU safety requires systematic examination of how the concept is used and understood across disciplines and regions. The initial step toward this goal was undertaken through collaborative discussions within the COST Action CA24107 – SAFE-ICU (Patient SAFety Related Outcome Measures in European ICUs). Through these discussions, the concept of “Safe ICU” was identified as a key construct requiring conceptual clarification to support ongoing work related to patient safety–related outcome measures across European region intensive care settings. To address this gap, the present study applies Walker and Avant’s concept analysis method (2019), a systematic and widely used approach in nursing and health sciences for clarifying complex or ambiguous concepts. This method enables structured exploration of a concept through identification of its uses, defining attributes, antecedents, consequences, and empirical referents, as well as the development of illustrative cases that clarify conceptual boundaries (Gunawan et al., 2023). Applying this framework will support a comprehensive conceptual examination of Safe ICU and facilitate the development of a clearer conceptual and operational definition relevant to intensive care research, clinical practice, and healthcare policy.
Lind et al. (Thu,) studied this question.