Public Release: 

Becoming the 'second victim': Most anesthesiologists have felt personally responsible for medical errors

ESA (European Society of Anaesthesiology)

New research presented at this year's Euroanaesthesia congress in Copenhagen, Denmark, shows the frequent but little-known problem of healthcare workers being seriously emotionally and professionally affected after an adverse patient outcome, leading them to become "second victims". The study is by David Sánchez Barcenilla and colleagues at the Department of Anaesthesiology, Resuscitation and Pain Therapy, Hospital Clinic - Barcelona, Spain.

Despite being barely known by health workers, the phenomenon of becoming a "second victim" after an adverse patient outcome is very common, affecting up to 72% of health workers. In line with the growing culture of safety and the open disclosure of adverse events, the authors suggest that educational plans need to be developed to make health professionals aware of the problem. They suggest that: "Implementing a second victim culture is essential to prevent terrible consequences for both second victims and health systems".

This study assessed awareness of the second victim concept among anaesthesiologists from different hospitals in Spain. The team conducted an anonymous survey of anaesthesiologists selected as part of a continuing education course, and was completed before a teaching module comprising a second victim simulation.

The survey was filled in by 34 anaesthesiologists (73% female, 27% male), most of whom worked at tertiary referral hospitals (77%) and at university hospitals (88%). There was a wide range of professional experience with 24% having fewer than 5 years, 44% having worked 5-10 years, and 32% having more than 10 years experience in their field. The vast majority (91%) admitted to having felt personally responsible for medical errors, with 26% of those mistakes resulting in severe injuries to a patient. The most common symptoms experienced by these second victims were a sense of guilt, lack of self-confidence at work, and anger. Less commonly, they also suffered from irritability, insomnia, or easy crying.

Among second victims 60% sought help, mostly by confiding in other colleagues, while 3% of those surveyed ended up needing professional support to cope with their experience. Many of those questioned had also been second victim helpers, with 80% admitting to having provided support to someone else in that predicament. Only half of them, however, claimed to have the necessary tools to adequately manage the situation by themselves.

The authors conclude that most of the anaesthesiologists they studied had been involved in a second victim situation, both as victims and as helpers (91% and 80% respectively), but only half of them believed that they had correct training to handle it. They say: "The high prevalence of the problem makes it essential to train health professionals to recognise second victims, know how to approach this situation, and determine when to request professional help." The team advise that second victim culture should be a crucial part of training alongside other quality and safety programmes.

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