Ashley K. Kable and Allan D. Spigelman
The purpose of this paper is to draw attention to the problem of second victims involved in adverse events and their need for adequate support.
Abstract
Purpose
The purpose of this paper is to draw attention to the problem of second victims involved in adverse events and their need for adequate support.
Design/methodology/approach
The impact on second victims involved in adverse events and implications for organisational support were determined from previous studies and relevant publications about this problem.
Findings
The impact of adverse events on health professionals who are involved in them can be profound. These second victims can suffer extreme emotional distress, anxiety regarding perceptions of their competence and professional isolation, and may endure long-term professional and personal consequences. Some of the more severe outcomes include leaving the profession, symptoms of post-traumatic stress disorder and suicide. Many studies report a substantial lack of organisational support for second victims. Key strategies have been recommended for organisations to implement to support second victims.
Originality/value
The authors note that recently published studies continue to report that organisational support is inadequate for second victims. Improved mechanisms of support would prevent the loss of second victims from the workforce, and ameliorate the severity and duration of the impact on second victims.
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Keywords
Ashley Kable, Robert Gibberd and Allan Spigelman
The purpose of this study is to measure the adverse event rates for five elective surgical procedures: transurethral resection of prostate, cholecystectomy, hysterectomy, joint…
Abstract
Purpose
The purpose of this study is to measure the adverse event rates for five elective surgical procedures: transurethral resection of prostate, cholecystectomy, hysterectomy, joint arthroplasty, and herniorrhaphy.
Design/methodology/approach
A retrospective two‐stage medical record review was conducted on 1,177 admissions in 1998 and 2000 at two tertiary hospitals. Records found to be positive for any of 17 screening criteria during the first stage were reviewed by surgeons from the relevant specialty for adverse events associated with the admissions.
Findings
The adverse event (AE) rate overall was 23.1 per cent. There were large variations between the procedural groups, ranging from 12.7 per cent (laparoscopic cholecystectomy) to 44.8 per cent (abdominal hysterectomy). Of the 272 AEs, 89 (32.7 per cent) had an unplanned readmission requiring 709 additional days in hospital and 55 (20.2 per cent) patients had additional surgery (seven returned to theatre during their admission for the procedure). AEs involving a disability that resolved within 12 months occurred for 91.2 per cent, 6.3 per cent had permanent disability, and 2.5 per cent resulted in death. The surgical reviewers determined that 24.7 per cent of the AEs were highly preventable.
Originality/value
The study confirms that surgical admissions have a high risk for AEs. The risk varies between procedural groups and 47.3 per cent are not preventable. Adverse events are an important patient safety issue. Preventing AEs would reduce readmissions, patient discomfort and associated costs. Routine monitoring of AEs is recommended.
Details
Keywords
Ashley Kable, Robert Gibberd and Allan Spigelman
The purpose of the paper is to measure compliance with agreed protocols for prophylactic antibiotics for five elective procedures: transurethral resection of the prostate…
Abstract
Purpose
The purpose of the paper is to measure compliance with agreed protocols for prophylactic antibiotics for five elective procedures: transurethral resection of the prostate, cholecystectomy, hysterectomy, joint arthroplasty and herniorrhaphy in two teaching hospitals.
Design/methodology/approach
Compliance was measured during the pre and post intervention periods by reviewing medical records.
Findings
Overall, compliance improved by 18 per cent (95 per cent CI: 12 per cent, 23 per cent) with greater improvements for transurethral resection of the prostate and hysterectomy, increasing by 27 per cent (95 per cent CI: 14 per cent, 40 per cent) and 24 per cent (95 per cent CI: 16 per cent, 32 per cent) respectively. Compliance remained low for cholecystectomy (17 per cent) and hysterectomy (25 per cent). Overall, the proportion of patients not receiving any prophylaxis where its use was indicated, declined by 6 per cent (95 per cent CI: 1 per cent, 11 per cent) from 23 per cent. The use of additional anti‐microbials that were not recommended in the protocol was high for joint arthroplasty 65 per cent and hysterectomy 71 per cent, but overall this practice declined by 8 per cent (95 per cent CI: 3 per cent, 14 per cent). Costs were reduced from $11.72 to $10.53 per patient between the pre and post intervention groups, while a complete adoption of the protocols could reduce costs by 70 per cent to $3.40. There were large variations in correct dosages and timing of antibiotics between procedural groups.
Practical implications
Although compliance improved there were large differences between the specialties. The adoption of preventive strategies is fundamental to providing safe patient care. The use of inappropriate antimicrobials is also an important patient safety issue that contributes to antibiotic resistance and is associated with increased costs. Introducing change in health organizations is difficult and the factors influencing successful change strategies require further study.
Originality/value
The paper measures and improves compliance with agreed protocols in health care intervention procedures.