Background
Methods
Questionnaire
Data analysis
Results
PRIMARY CARE (N = 610) | HOSPITAL (N = 477) | |||
---|---|---|---|---|
N | % | N | % | |
Professional group
| ||||
Doctors | 332 | 54.4 | 209 | 43.8 |
Nurses | 265 | 43.4 | 230 | 48.2 |
Other | 13 | 2.1 | 38 | 7.9 |
Age (years) | ||||
<30 | 10 | 1.6 | 21 | 4.4 |
31-50 | 310 | 50.8 | 280 | 58.7 |
51-70 | 287 | 47.0 | 172 | 36.1 |
DK/NR | 3 | 0.5 | 4 | 0.8 |
Sex
| ||||
Male | 151 | 24.8 | 145 | 30.4 |
Female | 451 | 73.9 | 326 | 68.3 |
DK/NR | 8 | 1.3 | 6 | 1.3 |
Professional experience (years) | ||||
<1 - 3 | 3 | 0.5 | 14 | 2.9 |
>3 | 603 | 98.9 | 460 | 96.4 |
DK/NR | 4 | 0.7 | 3 | 0.6 |
Frequency of patient safety incidents
| ||||
Reports of safety incidents (near misses) | 465 | 76.2 | 439 | 92.0 |
Reports of serious adverse events for one or more patients | 287 | 47.0 | 341 | 75.4 |
Service (department/unit, etc.)
| ||||
Medical | -- | 185 | 38.8 | |
Surgical | -- | 92 | 19.3 | |
Central | -- | 82 | 17.2 | |
Other | -- | 105 | 22.0 | |
DK/NR | -- | 13 | 2.7 | |
DK/NR: Do not know or no response |
Primary care (N=597) | Hospitals (N=439) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
In the previous 5 years | Doctors | % | Nurses | % | P= | Doctors | % | Nurses | % | P= |
In my hospital, I know of cases that could be considered near misses (incidents that could have led to serious adverse events but which were corrected in time). | 251 | 75.6 | 207 | 78.1 | 0.533 | 193 | 92.3 | 216 | 93.9 | 0.645 |
I know of cases of adverse events with serious consequences for one of more patients. | 174 | 52.4 | 105 | 39.6 | 0.002 | 168 | 80.4 | 148 | 64.3 | 0.001 |
I have been personally involved in informing patients who have suffered an adverse event (or their relatives) | 155 | 46.7 | 66 | 24.9 | 0.001 | 133 | 63.6 | 66 | 28.7 | 0.001 |
I know of cases of professionals who have suffered emotionally after an AE in a patient. | 223 | 67.2 | 158 | 54.9 | 0.008 | 162 | 77.5 | 184 | 68.7 | 0.140 |
I know of cases of health professionals who have had work-related problems due to an AE. | 99 | 29.8 | 72 | 27.2 | 0.535 | 64 | 30.6 | 64 | 27.8 | 0.590 |
In your experience, what happens when a patient who has suffered an adverse event is informed?* | ||||||||||
The patients accepts the explanation given | 239 | 84.8 | 179 | 87.3 | 0.503 | 168 | 91.8 | 164 | 84.1 | 0.033 |
The relationship with the patient worsens | 77 | 27.5 | 50 | 25 | 0,612 | 36 | 19.8 | 63 | 32.8 | 0.006 |
The patient files a formal complaint | 28 | 10.1 | 34 | 16.8 | 0.043 | 45 | 25.1 | 42 | 22.6 | 0.652 |
The patient responds aggressively | 39 | 14.1 | 36 | 17.7 | 0.345 | 21 | 11.9 | 37 | 19.9 | 0.052 |
Patient safety culture
Open disclosure experience
Second victim experience
Primary care (N=458) | Hospital (N=360) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Doctors (N=267) | Nurses (N=191) | Doctors (N=182) | Nurses (N=178) | |||||||
N | % | N | % | P= | N | % | N | % | P= | |
Required time off work | 74 | 27.8 | 52 | 27.7 | 1.00 | 25 | 13.7 | 43 | 24.2 | 0.017 |
Requested transfer to a different department/unit or health centre | 41 | 15.4 | 36 | 18.8 | 0.288 | 18 | 9.9 | 45 | 25.1 | 0.001 |
Left the profession | 8 | 3.0 | 5 | 2.6 | 1.00 | 3 | 1.7 | 3 | 1.7 | 1.00 |
Primary care | Hospital | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Doctors (N = 332) | Nurses (N = 265) | Doctors (N = 209) | Nurses (N = 230) | |||||||
In the case that you or a colleague has been involved in a serious adverse event, indicate the frequency of the following responses | Mean | SD | Mean | SD | P= | Mean | SD | Mean | SD | P= |
Feeling dazed/confusion/difficulty concentrating on work, in the days after an adverse event | 2.3 | 0.8 | 2.0 | 0.8 | 0.000 | 2.0 | 0.7 | 2.1 | 0.9 | 0.086 |
Feelings of guilt | 2.9 | 0.7 | 2.5 | 0.8 | 0.000 | 2.7 | 0.8 | 2.9 | 0.9 | 0.003 |
Pessimism about life/sadness | 2.2 | 0.8 | 2.0 | 0.8 | 0.001 | 2.1 | 0.7 | 2.2 | 0.9 | 0.382 |
Tiredness | 2.5 | 0.8 | 2.2 | 0.8 | 0.000 | 2.3 | 0.8 | 2.3 | 0.9 | 0.709 |
Anxiety | 2.7 | 0.8 | 2.4 | 0.9 | 0.001 | 2.4 | 0.8 | 2.6 | 0.9 | 0.075 |
Insomnia/trouble sleeping well | 2.5 | 0.8 | 2.2 | 0.8 | 0.005 | 2.2 | 0.8 | 2.4 | 0.9 | 0.084 |
Re-living the event, again and again | 2.6 | 0.8 | 2.2 | 0.8 | 0.000 | 2.3 | 0.8 | 2.5 | 0.9 | 0.187 |
Anger and mood swings at work | 2.1 | 0.7 | 1.9 | 0.7 | 0.029 | 2.0 | 0.7 | 2.0 | 0.8 | 0.847 |
Anger and mood swings at home | 2.2 | 0.7 | 2.0 | 0.8 | 0.005 | 2.1 | 0.7 | 2.1 | 0.8 | 0.772 |
Constant doubts about what to do and whether clinical decisions are correct | 2.4 | 0.7 | 2.1 | 0.7 | 0.000 | 2.2 | 0.7 | 2.3 | 0.8 | 0.165 |
Concern about loss of standing among colleagues | 1.6 | 0.6 | 1.7 | 0.7 | 0.806 | 1.6 | 0.7 | 1.8 | 0.8 | 0.008 |
Concern about loss of standing among patients | 1.9 | 0.6 | 1.7 | 0.7 | 0.020 | 1.5 | 0.6 | 1.7 | 0.8 | 0.003 |
Questioning whether to leave the profession | 1.8 | 0.8 | 1.5 | 0.7 | 0.000 | 1.5 | 0.6 | 1.6 | 0.8 | 0.456 |
Response options for all items from 1 (never) to 4 (always) |
Primary care | Hospital | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Doctors (N = 332) | Nurses (N = 265) | Doctors (N = 209) | Nurses (N = 230) | |||||||
In event of a clinical error, indicate how often those involved are likely to do the following | Mean | SD | Mean | SD | P= | Mean | SD | Mean | SD | P= |
Say sorry to patients (or their relatives) | 6.9 | 2.3 | 7.1 | 2.5 | 0.437 | 6.1 | 2.9 | 6.0 | 2.9 | 0.605 |
Face legal action | 8.0 | 1.9 | 7.3 | 2.2 | 0.000 | 7.8 | 2.0 | 7.7 | 2.2 | 0.734 |
Lose professional standing | 7.2 | 2.2 | 7.0 | 2.4 | 0.422 | 6.6 | 2.4 | 7.3 | 2.4 | 0.006 |
Inform the clinical manager of the health centre/hospital of the error | 5.4 | 2.8 | 5.5 | 2.6 | 0.711 | 5.5 | 2.8 | 5.1 | 2.7 | 0.223 |
Come into conflict with colleagues (reproach or criticism) | 4.6 | 2.7 | 4.6 | 2.5 | 0.778 | 5.0 | 2.6 | 5.3 | 2.8 | 0.299 |
Frequency scale from 0 (never) to 10 (always) |
Discussion
Conclusions
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Six out 10 health professionals in Spain have known the second victim experience.
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The experience of second victims in Spain cause guilt and anxiety but with some extra factors: doubts regarding informing patients, colleagues and managers about what has happened, fear of the legal consequences, and concerns about a loss of standing.
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In the Spanish context, doctors worry more than nurses about the negative professional consequences of AEs. There are also differences in the aftermath in PC or hospitals.
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Spanish health professionals rarely receive any training or education on coping strategies for this phenomenon