Our multiple columns on “the second victim” (see list at the end of today’s column) discuss the evolution of the approach to helping second victims. Back in the early 1990’s as we began dealing with investigations on serious events we recognized that those healthcare workers involved in serious events, either directly or indirectly, often had difficulty coping in the aftermath of such events. But while we recognized the issue of the second victim in those early days of patient safety, we didn’t really know how to best help them. We often simply made available to them professional assistance (employee assistance programs or psychological counselling). Over the years, helping the “second victim” has evolved considerably and such referral for professional help is not a good first line strategy and may even be counterproductive. Support from peers is extremely important if such programs are to be successful.
Some healthcare organizations have been reluctant to help fund the resources needed to have successful second victim programs. At Johns Hopkins, where Albert Wu originally coined the term “second victim” to describe such individuals and their plight (Wu 2000), its RISE (Resilience In Stressful Events) program is an emotional peer support structure to support “second victims” who were emotionally impacted by a stressful patient-related event or unanticipated adverse event. A multidisciplinary peer responder team who have volunteered to support second victims responds when an unanticipated patient-related event occurs. Researchers there recently did a cost benefit analysis of their program as it pertains to nursing staff, modeling the cost of running the RISE program, nurse turnover, and nurse time off (Moran 2017).
Their model predicted the RISE program has a net monetary benefit savings of US $22,576.05 per nurse who initiated a RISE call. They estimated that a hospital could save US $1.81 million each year because of the RISE program. The annual cost of the RISE program per nurse was roughly $656 but the expected annual cost saved from nurse time off or nurse turnover was $23,232, for the estimated net cost savings of $22,576. The authors conclude that hospitals should be encouraged by these findings to implement institution-wide support programs for staff, based on a high demand for this type of service and the potential for cost savings.
As an aside, while the Moran study focuses preferentially on nurses as second victims, don’t forget that any healthcare worker may be a second victim. Another recent study (Han 2017) looked at surgeons involved in intraoperative adverse events (iAE’s). They surveyed surgeons at 3 major teaching hospitals. They found the emotional toll of iAE’s was significant, with 84% of respondents reporting a combination of anxiety (66%), guilt (60%), sadness (52%), shame/embarrassment (42%), and anger (29%). Colleagues constituted the most helpful support system (42%) rather than friends or family; a few surgeons needed psychological therapy/counseling.
We refer you to our previous columns on the second victim for descriptions of good programs to help address the issues impacting second victims. We don’t doubt that the sort of ROI on such programs would apply to all healthcare workers, though the relative dollar amounts as seen in the Moran study may vary by type of worker.
Some of our prior columns on “the second victim”:
Wu AW. Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ 2000; 320: 726–727
Moran D, Wu AW, Connors C, et al. Cost-Benefit Analysis of a Support Program for Nursing Staff. Journal of Patient Safety 2017; Post Author Corrections: April 27, 2017
Han K, Bohnen JD, Peponis T, et al. The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons' Attitude (BISA) Study. J Amer Coll Surg 2017; 224(6): 1048-1056 Published online: January 14, 2017