Surgeons as second victims: Clinicians may experience trauma after adverse events

When discussing complications, we have traditionally focused on the most obvious victim, the patient. However, surgeons are not immune to the trauma that occurs after a patient suffers an adverse event and, in fact, they may become “second victims.” As reported in a 2015 article from the British Medical Journal, 80 percent of surveyed surgeons said they experienced at least one intraoperative adverse event within the past year that had a substantial impact on their emotional well-being. Some of these second victims described feelings of sadness, anxiety, and shame; others stated they needed formal psychological counseling.*

A real-world example

It is estimated that nearly half of all health care professionals could experience a second victim event at least once in their career. With this statistic in mind, this topic is the focus of the January 2018 Quick Safety, which includes an anonymous, personal story of a Joint Commission employee who identifies as a second victim.

The employee previously was an operating room nurse. In the narrative, the nurse recalls being with a clinician who was performing a cervical epidural steroid injection. The patient postoperatively developed a spinal hematoma that led to permanent paralysis.

The patient had been taking an anticoagulant that should have been discontinued days before the procedure. Because the patient completed consent forms and received preoperative instructions at the physician’s office, when he came in for the procedure the assumption was made that he was no longer taking anticoagulant medication.

“Days after the event, the director of nursing asked me to her office to discuss the patient safety event; it was never discussed after that,” wrote the nurse in the Quick Safety report. “I continued working with the same team, but the event was like an elephant in the room all the time. I kept wondering, ‘What did I do wrong? How did this happen?’ I felt guilty and had doubts about my skills as a nurse.” Unfortunately, the nurse received no emotional support.

Potential effects

The Quick Safety published at the beginning of the year details the potential effects of second victim experiences that can lead to compromised patient safety, including the following:

  • Difficulty sleeping
  • Reduced job satisfaction
  • Guilt
  • Anxiety (including fear of litigation or job loss)

Some second victims may experience recurring memories of the event that can lead to burnout, depression, and/or suicidal thoughts. Some second victims also may feel isolated from coworkers.

The Quick Safety issue lists several systems-based second victim safety actions including the following:

  • Instill a just culture for learning from system defects and communicating lessons learned
  • Engage all team members in the debriefing process and sharing of the lessons learned from the event analysis
  • Provide guidance on how staff can support each other during an adverse event (that is, how to offer immediate peer-to-peer emotional support or buddy programs)
  • If the employee assistance program (EAP) is the sole source of support for second victims, consider creating supplemental programs after evaluating the EAP’s structure and performance

Disclaimer

The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.


*Stewart K, Lawton R, Harrison R. Supporting “second victims” is a system-wide responsibility. BMJ. 2015;350:h2341. Available at: www.academia.edu/12516945/Supporting_second_victims_is_a_system-wide_responsibility. Accessed February 28, 2018.

Seys D, Wu AW, Van Gerven E, et al. Health care professionals as second victims after adverse events: A systematic review. Eval Health Prof. 2012;36(2):135-162.

The Joint Commission. Supporting second victims. Quick Safety, Issue 39. January 2018. Available at: www.jointcommission.org/assets/1/23/Quick_Safety_Issue_39_2017_Second_victim_FINAL2.pdf. Accessed February 26, 2018.

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