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Caring for the second victims

The care of second victims responds to the following objectives:

  1. It must be considered that when an adverse event occurs the professional doubts his or her capacity for clinical judgement. It is therefore necessary to adopt measures to ensure the quality of health care, considering that a premise for guaranteeing quality is that professionals feel that they have sufficient capacity to carry out their work in an appropriate environment. A supportive environment, a supportive organisation and an integrated team of professionals are prerequisites for providing optimal care.
  1. Minimise the negative emotional impact on second victims of unexpected incidents such as adverse events by providing them with the necessary support, which has a positive impact on safety of the following patients to be cared.
  1. Avoiding non-quality costs, since the individual and social effort involved in training a healthcare professional(s) is cut short when the professional doubts his or her clinical judgement and ability to continue in his or her profession and decides to leave or change position. The feeling of lack of protection reduces the quality of care, causes disaffection among professionals and, in short, makes it difficult, if not impossible provide optimal care. But this approach requires a non-punitive environment were talking about what happened does not have additional negative consequences.

The Second Victim Experience and Support Tool (SVEST) was created to better understand the needs of the second victims and to assist the implementation of support resources by the institutions.1 It was created and validated in the United States but currently it is also available in other languages. 

Using this tool Burlison et al1 found that the majority of the healthcare workers surveyed would prefer to have a “respected peer to discuss the details of what happened” when asked about the desirability of 7 support options.

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Accordingly, the peer support is the basis of several interventions directed to the second victims.

Peer Support is “emotional first aid” for healthcare providers who are involved in unanticipated adverse patient events, medical errors, or other stressful situations encountered through patient care. Providers involved in such events are often referred to as Second Victims, as they suffer significant emotional, physical, cognitive, and behavioural sequelae in the aftermath of such events. Peer Support is an effective tool in helping staff successfully manage difficult situations, increase resiliency, and decrease burnout.

The three-stage intervention model suggested by Susan Scott is the most widespread. It is based on peer support, first from the unit itself (basic emotional first aid) and at a second level by trained peers. The third level is based on more specialised support. 

In most cases, the tier 1 will provide sufficient support to the victims; it is composed by peers and unit leaders that should have received some basic awareness training to the second victim’s needs. When necessary, the second victims can be referred for tier 2, where specially trained peers can provide guidance and support. When the needs of the second victims exceeds the expertise of the peer supporters, they can be referred for Tier 3, composed by professional counsellors. 

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In the ERNST Case Study #1 different programs to support the second victims are detailed:

  • KoHi Project at Hietzing Clinic (Vienna, Austria) – peer-based intervention
  • MISE program – online intervention (Spain)
  • RISE (Johns Hopkins Hospital, Baltimore, USA) – peer-based intervention
  • Second victim support flow at Hospital Israelita Albert Einstein (São Paulo, Brazil). 
  • forYOU team (University of Missouri Health System, Missouri, USA) – peer-based intervention.

During the new corona pandemic, Scott’s model has been the basis for interventions to support frontline professionals in the care of COVID-19 patients2:

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  1. Burlison, J.D., Scott, S.D., Browne, E.K., Thompson, S.G., & Hoffman JM. The second victim experience and support tool (SVEST): Validation of an organizational resource for assessing second victim effects and the quality of support resources. J Patient Saf. 2017;13(2):93–102.
  2. Strametz R, Raspe M, Ettl B, Huf W, Pitz A. Recommendations: Maintaining capacity in the healthcare system during the COVID‐19 pandemic by reinforcing clinicians’ resilience and supporting second victims. German Coalition for Patient Safety, Austrian Network for Patient Safety; 2020.

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