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Supporting second victims

Residency Program Insider, January 4, 2019

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Editor's Note: The following excerpt is from Residency Program Alert. 

More attention is being paid to second victims, and support options are slowly growing. Leaders, administrators, and safety and risk officers have become more understanding that doctors, nurses, and specialists directly involved in an adverse patient event or traumatic episode are likely to suffer an emotional response causing sleep deprivation, guilt, anxiety, or reduced job satisfaction.

Albert Wu, MD, MPH, professor of Health Policy and Management at the Johns Hopkins School of Public Health, coined the term “second victim” in 2000 to acknowledge that a caregiver involved in the death or serious injury of a patient can be emotionally traumatized by the event, too. A 2013 review published in the Evaluation & The Health Professions journal concluded that nearly half of all healthcare professionals experience second-victim syndrome at least once.

Last year, a survey of surgeons found that 80% recalled experiencing at least one intraoperative adverse event at their practice during the previous year. Those affected reported a substantial impact on their well-being, including strong feelings of sadness, anxiety, and shame.

What kind of concerning behavior should you look out for after such an adverse event?

“The biggest red flag is isolation,” says Eric Wei, NYC Health + Hospitals chief quality officer. “Second victims tend to isolate themselves and suffer alone. So, if somebody closes off, stops communicating, stops interacting with peers, that’s a warning sign, or people who are not coming to work, so a lot more sick days, stress days. And then your typical signs of depression and PTSD: being down, not finding joy in their work or in their personal life, certain events [reminding them of] their case, avoiding certain types of cases.”

If unaddressed, these adverse events can lead to burnout, depression, and suicidal ideation. According to the American Foundation for Suicide Prevention, 300–400 physicians die by suicide in the United States every year. And yet, many healthcare organizations still struggle to appropriately address the support of these second victims, in part because few seek help.

One 2017 study, based on interviews with patient safety officers in acute care hospitals in Maryland, highlighted numerous barriers keeping physicians, nurses, and other healthcare staff from obtaining help after an adverse event. Chief among them were fear about confidentiality, negative judgment by cowork-ers, and the stigma of using emotional support services.

Now, second-victim support programs are popping up in hospitals and medical centers across the country and seek to break through these barriers to get all healthcare staff the support they need.

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