OBJECTIVES: Drug shortages are a complex and global phenomenon. When a drug cannot be delivered at the moment of patient demand, every stakeholder in the health care system is affected. METHODS: This study aims to investigate the characteristics, clinical impact, financial impact and management of drug shortages in European hospital pharmacies. An online survey was designed based on literature and interviews with Belgian pharmacists. The online survey was sent to subscribers of Hospital Pharmacy Europe between June and September 2013. Descriptive statistics of the respondent’s answers were calculated. RESULTS: One hundred sixty-one respondents were considered in this study. Results show variations between drug shortage characteristics in European regions and countries. Besides manufacturing problems, a role for European and national policy measures related to the market access and trade of pharmaceuticals, such as tendering and parallel trade, are discussed as a root cause for drug shortages. Further, respondents indicate drug shortages in Europe are associated with clinical risks for patients such as medication errors, a financial burden on hospitals and increased workload for the hospital pharmacy. The median number of hours spent to the management of drug shortages by hospital pharmacists was estimated to be 12.85hours/week. While pharmaceutical companies and wholesalers already assist the hospital pharmacy in the management of shortages, a role is still reserved for the government. CONCLUSIONS: This study showed drug shortages have a significant effect on hospitals, their personnel and patients. Mandatory notification in advance and centralized information is proposed to reduce workload for hospital pharmacists. Further, this will allow early anticipation of drug shortages and facilitates mitigation of the clinical impact on patients. Monitoring of the effect of policy measures on the availability of drugs is required to reveal and tackle the root causes behind drug shortages.