Sometimes, the patients don’t survive. Doctors and nurses make mistakes, or aren’t able to treat an injury fast enough, or can’t diagnose what’s wrong until it’s too late.
Such incidents can place a heavy emotional burden on caregivers. These so-called “second victims” can experience feelings of guilt and isolation as well as a dangerous lack of confidence.
But a pilot program launched this month at Greater Baltimore Medical Center is aimed at providing “psychological first-aid” to these caregivers through peer-to-peer counseling.
“We felt it was important that there be a mechanism to support our staff,” said Carolyn Candiello, vice president of quality and patient safety at GBMC.
A rotating group of volunteers — including doctors, nurses, and hospital technicians — will be on-call 24-hours a day to provide confidential support to caregivers in the wake of those events.
About 20 volunteers from the hospital staff are participating in the pilot, and teams of four will be on-call for a week at a time, Candiello said.
And while the “second victim” phenomenon is often linked to errors made during treatment, it can also just be the product of unexpectedly intense situations with patients. “You never know what might come in through the emergency room,” Candiello said.
A “second victim” could also be a new nurse witnessing his or her first unresponsive or dying patient, she said.
The program was developed by the nonprofit Maryland Patient Safety Center and the Johns Hopkins Hospital Armstrong Institute for Patient Safety and Quality.
A second pilot is expected to launch at the University of Maryland Medical System next month, said Robert Imhoff, the center’s president.
Feelings of guilt and remorse are often amplified for doctors and nurses because their job is to heal, so a key element of the program is that it allows the caregiver to talk about the situation without blaming or judgment, Imhoff said.
Ideally, caregivers will seek help from a peer within 24 hours of the incident to begin working through it, Imhoff said.
“We’ve heard anecdotally from second victims about how important this is,” Imhoff said, recalling a man he met at a conference who said a bad experience with a patient had haunted him for 10 years because he felt he had no one to talk to. The man eventually left medicine.
“We’re often seeing people leave the profession,” Imhoff said. Doctors and nurses that do stay can find their confidence badly shaken, he said.
Treating the emotional trauma can help prevent hospitals from needing to replace doctors and nurses and can be a strong testament to the support hospitals offer their employees, Imhoff said.
It’s difficult to know the extent of the “second victim” phenomenon — in part because those who experience it may not talk about it — but literature suggests it occurs worldwide and awareness of the problem is growing, Candiello said.
One of the goals of the program is to collect more data on the phenomenon in local hospitals, Imhoff said.
A similar program has been in place at the University of Missouri health system since 2009, offering employees and faculty members 24-hour access to a team of peer volunteers.
That program, known as the forYou Team, provides support to an average of 200 employees a year. People seek help not only after stressful events involving patients, but also for events such as the death of a family member outside the workplace, according to a spokesman.