Objectives Second victim experiences can affect the well-being of healthcare providers and compromise patient safety. The purpose of this study was to assess the relationships between self-reported second victim–related distress to turnover intention and absenteeism. Organizational support was examined concurrently because it was hypothesized to explain the potential relationships between distress and work-related outcomes. Methods A cross-sectional, self-report survey (the Second Victim Experience and Support Tool) of nurses directly involved in patient care (N = 155) was analyzed by using hierarchical linear regression. The tool assesses organizational support, distress due to patient safety event involvement, and work-related outcomes. Results Second victim distress was significantly associated with turnover intentions (P < 0.001) and absenteeism (P < 0.001), while controlling for the effects of demographic variables. Organizational support fully mediated the distress–turnover intentions (P < 0.05) and distress-absenteeism (P < 0.05) relationships, which indicates that perceptions of organizational support may explain turnover intentions and absenteeism related to the second victim experience. Conclusions Involvement in patient safety events and the important role of organizational support in limiting caregiver event–related trauma have been acknowledged. This study is one of the first to connect second victim distress to work-related outcomes. This study reinforces the efforts health care organizations are making to develop resources to support their staff after patient safety events occur. This study broadens the understanding of the negative effects of a second victim experience and the need to support caregivers as they recover from adverse event involvement.

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Purpose This study aims to (1) describe the health-related quality of life (HRQoL) outcomes experienced by children born very preterm (28–31 weeks’ gestation) and extremely preterm (< 28 weeks’ gestation) at five years of age and (2) explore the mediation effects of bronchopulmonary dysplasia (BPD) and severe non-respiratory neonatal morbidity on those outcomes. Methods This investigation was based on data for 3687 children born at < 32 weeks’ gestation that contributed to the EPICE and SHIPS studies conducted in 19 regions across 11 European countries. Descriptive statistics and multi-level ordinary linear squares (OLS) regression were used to explore the association between perinatal and sociodemographic characteristics and PedsQL™ GCS scores. A mediation analysis that applied generalised structural equation modelling explored the association between potential mediators and PedsQL™ GCS scores. Results The multi-level OLS regression (fully adjusted model) revealed that birth at < 26 weeks’ gestation, BPD status and experience of severe non-respiratory morbidity were associated with mean decrements in the total PedsQL™ GCS score of 0.35, 3.71 and 5.87, respectively. The mediation analysis revealed that the indirect effects of BPD and severe non-respiratory morbidity on the total PedsQL™ GCS score translated into decrements of 1.73 and 17.56, respectively, at < 26 weeks’ gestation; 0.99 and 10.95, respectively, at 26–27 weeks’ gestation; and 0.34 and 4.80, respectively, at 28–29 weeks’ gestation (referent: birth at 30–31 weeks’ gestation). Conclusion The findings suggest that HRQoL is particularly impaired by extremely preterm birth and the concomitant complications of preterm birth such as BPD and severe non-respiratory morbidity.

Background:Hospitalized pediatric oncology and hematopoietic stem cell transplant (HSCT) patients have frequent clinical deterioration requiring transfer to the Pediatric Intensive Care Unit (PICU). Pediatric Early Warning Systems (PEWS) can aid early identification of clinical deterioration and improve outcomes in these patients.Objectives:Describe the impact of PEWS implementation in a dedicated pediatric hematology-oncology/HSCT hospital.Methods:A PEWS tool and escalation algorithm were implemented between August and October 2016 (Fig. 1). Implementation quality was evaluated by measuring errors in PEWS calculation, omissions, and algorithm activation. Frequency of emergency activations and method of unplanned PICU transfer were compared before and after PEWS implementation.Results:Random monitoring of PEWS scores demonstrated 12.7% calculation errors, 3.8% omissions, and 1.7% algorithm errors. Omissions and algorithm errors decreased over time following implementation (P < 0.0001 and P = 0.005, respectively). Frequency of Rapid Response Team (RRT) activations increased after PEWS implementation from 1.3 to 12.2/1,000-inpatient-days (P < 0.0001), without an increase in Code Blue activations (1.2 to 0.97/1,000-inpatient-days, P = 0.49, Fig. 2) and no change in frequency of unplanned PICU transfers (5.7/1,000-inpatient-days before and after PEWS implementation). Unplanned PICU transfers arriving via RRT increased from 11.5% to 60.5% of admissions (P < 0.0001, Fig. 3).Conclusions/Implications:PEWS can be successfully implemented in a pediatric hematology-oncology/HSCT hospital with improvement in accuracy over time. Implementation of PEWS resulted in increased use of the RRT system and more patients with clinical deterioration arriving to the PICU via an organized escalation pathway, representing standardization of care and improvement in the culture of safety in the hospital.

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