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Introduction: While the popularity of international care is rising, the complexity of international care compromises patient safety. To identify risks and propose solutions to improve international care, this study explores experiences of healthcare workers with international handovers in a European border region. Methods: A cross-sectional survey design was used to reach out to 3000 healthcare workers, working for hospitals or emergency services in three neighboring countries in the Meuse-Rhine Euregion. In total, 846 healthcare workers completed the survey with 35 closed- and open-ended questions about experiences with international patient handover. Results: One-third of respondents had been involved in international handover in the previous month. The handovers occurred in planned and acute care settings and were supported by numerous, yet varying standardized procedures. Healthcare workers were trained for this in some, but not all settings. Respondents mentioned 408 risks and proposed 373 solutions, which were inductively analyzed. Six identified themes classify the level on which risks and accompanying solutions can be found: awareness, professional competencies, communication between professionals, loss of information, facilities and support, and organizational structure. Discussion: This study gives insight in international patient handovers in a European border region. Among the biggest risks experienced are procedural differences, sharing patient information, unfamiliarity with foreign healthcare systems, and not knowing roles and responsibilities of peers working across the border. Standardization of procedures, harmonization of systems, and the possibility for healthcare workers to get to know each other will contribute to reach common ground and move towards optimized and patient-safer cross-border care. [ABSTRACT FROM AUTHOR]

This paper outlines the main findings from case studies analysed within the Practical Evaluation Tools for Urban Sustainability (PETUS) project, about the practical use of tools for sustainable urban development in European cities. The paper looks across 60 case studies and identifies the main drivers for using tools, the benefits gained by using them and discusses why, in general, there is limited use of available tools. The main question raised by the PETUS project was, ‘why are so few tools for urban sustainability being used, when so many are available?’ Recent years have shown a growing number of theoretical tools to assess and evaluate urban sustainability. However, experience also shows that only a few of such tools are being used in practice. The paper outlines the motivations for actors to use tools, the benefits achieved and the barriers for using tools. From this, different possibilities for improvements in the use of tools are discussed. [ABSTRACT FROM AUTHOR]