What’s New in the Patient Safety World
August 2017
ROI for a Second Victim Program
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”:
- December 17, 2013 “The
Second Victim”
- July 14, 2015 “NPSF’s
RCA2 Guidelines”
- June 2016 “Disclosure
and Apology: The CANDOR Toolkit”
- August 9, 2016 “More
on the Second Victim”
References:
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
http://www.journalacs.org/article/S1072-7515(17)30035-2/fulltext
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