Second victims

More than one victim after an adverse event

Recent studies show that serious adverse events occur in one out of seven patients. When such an adverse event occurs, there can be three types of victims: the first is the patient and the involved family, the second is the involved healthcare professional and the third is the involved health care organization which can also suffer a potential loss from the incident, such as no-shows or image loss. The focus of this website is on the “second victim”. These so-called “second victims” can suffer on both professional and personal level. Symptoms may include insomnia, nightmares, reliving the incident repeatedly, loss of trust by their colleagues, lack of self–confidence and fear of making another error.

Read our main publication on the Duration of second victim symptoms in the aftermath of a patient safety incident and association with the level of patient harm, as published in BMJ Open.

Definition

A second victim has been defined by  Scott et al. as: “a health care provider involved in an unanticipated adverse patient event, medical error and/or a patient related-injury who become victimized in the sense that the provider is traumatized by the event. Frequently, second victims feel personally responsible for the unexpected patient outcomes and feel as though they have failed their patient, and feel doubts about their clinical skills and knowledge base.”

Impact

The impact of an adverse event can be influenced by the outcome of the error and the degree of personal responsibility.

The health care professional can experience a professional impact, such as:
Different attitude within the team
Insecure feeling in presence of the team
Different attitude in presence of patients and their family
Uncertainty which elevates the chance in making other mistakes
Burnout

The health care professional can also experience a personal impact, such as:
Post traumatic stress
General stress symptoms
Anger
Insomnia
Nervousness
Effect on family life
Depression

Importance

This “second victim phenomenon” has a significant impact on the health care professional, colleagues, and subsequent patients. Second victims in health care are struggling personally and professionally in the aftermath of unexpected clinical events, which can contribute to a negative impact on patient care. It is critical that support networks are in place to protect both the patient and involved health care providers. Although there is a growing awareness that talking about adverse events is necessary to improve patient safety, it often remains a taboo. It is an important pillar in the search for an optimal patient safety climate.

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