The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons' Attitude (BISA) Study

Han, Kelsey; Bohnen, Jordan D.; Peponis, Thomas; Martinez, Myriam; Nandan, Anirudh R.; Yeh, D. Dante; Lee, Jarone; DeMoya, Marc; Velmahos, George C.; Kaafarani, Haytham M.A.

doi:10.1016/j.jamcollsurg.2016.12.039

Cited by 130 publications

(159 citation statements)

References 24 publications

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“…A recent study surveyed 126 surgeons across three teaching hospitals of the same university and identified intraoperative adverse events as occurring anywhere from one (32%) to more than six (9%) times in a given year. 34 In the wake of these events, 84% of respondents reported emotions on a spectrum consistent with SVS and affirmed both a fear of litigation and concern for lack of a standardized reporting system. 34 Given these data and the troubling relationship between burnout and SVS, it is important to appreciate that administrative support following medical errors may not address burnout per se, thereby leaving open the potential for ongoing negative effects on patient outcomes and cost of care.…”

Section: Burnout and The "Second Victim"mentioning

confidence: 99%

Surgeon Burnout: Defining, Identifying, and Addressing the New Reality

Senturk

Melnitchouk

2019

Clinics in Colon and Rectal Surgery

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Surgeon wellness is a multidimensional commitment that encompasses occupational, mental, physical, emotional, and social domains. Loss of professional control, autonomy, and flexibility; inefficient processes; disjointed workplace relationships and goals; excessive administrative burdens; poor work–life balance; and frustrations with medical record and order entry systems have all been associated with burnout. Described as a syndrome of emotional exhaustion, depersonalization, and loss of a sense of personal accomplishment, burnout can have myriad untoward consequences. The strong link between surgeons' personal and professional identities can lead to a perfect storm of burnout, depression, compromised patient safety and quality of care, physician job loss and career dissatisfaction, substance abuse, damage to personal relationships, and suicide. The alarming scope of this problem cannot be confined to a single specialty or practice setting and is expected to increase without much needed changes to surgeon work practices and work environments. A heightened focus on wellness in the workplace with attention to improving workflow, scheduling, collaboration, and resource allocation is a welcome step taken by several institutions and championed by professional societies. Much more research is needed to reliably gauge the overall effectiveness of these approaches, further address the nuances of burnout as it applies specifically to surgeons, and ensure that members of the surgical workforce remain at their peak throughout the duration of their careers.

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Section: Burnout and The "Second Victim"mentioning

confidence: 99%

Surgeon Burnout: Defining, Identifying, and Addressing the New Reality

Senturk

Melnitchouk

2019

Clinics in Colon and Rectal Surgery

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“…[5][6][7][8][9][10][11][12][13][14][15] In addition, our study brought up a distinction of three different ways in which interviewees (physicians) coped during their recovery process. In a hospital without an appropriate collegial support program, the extent to which support is given depends on the willingness of a close colleague to do so.…”

Section: Recovery Processmentioning

confidence: 99%

“…[4] Second victims feel confused and experience emotions of anger, anxiety, guilt, grief, self-criticism, and shame. [5][6][7][8][9][10][11][12][13][14][15] These emotions have an impact on both their professional and personal lives. [14,15] Second victims therefore need time to recover from adverse events.…”

Section: Introductionmentioning

confidence: 99%

The need and availability of support systems for physicians involved in a serious adverse event

Leferink

Bos²,

Heringa

et al. 2018

JHA

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Objective: Serious adverse events occur in healthcare, and do not solely have consequences for patients (first victims), but also affect physicians involved (second victims). These second victims experience diminished emotional well-being and less professional performance. An increasing number of hospitals organize support for second victims, although scientific evidence on the kind of support that is expected and needed is poor. This study therefore investigates support needs after serious adverse events from both personal (physicians) and organizational (quality and safety staff members) perspectives. Methods: We conducted semi-structured interviews in a Dutch university medical center. Physicians (N = 19) who had been directly involved in a serious adverse event participated. In addition, quality and safety staff members (N = 3) reflected on the support needs as expressed by physicians. Verbatim transcripts were three-fold coded, which led to several themes for our inductive thematic analysis. Results: Contrary to recent developments in healthcare organizations, participants did not plea for a hospital-wide support team. Acceptance of the emotional and professional impact of an adverse event by direct colleagues and supervisors is more important. Where such a cultural context is provided, physicians prefer support of a close and reliable colleague to cope with emotions and doubts, a supervisor who monitors recovery, and a healthcare organization that provides information about required procedures to learn from the events. However, this ideal was seldom found in the competitive working environment. This underlines the need for a shift from a competitive professional culture into a more supportive one. Conclusions: Ideally, direct colleagues support each other after an adverse event. This form of collegial support can only be successful if there is general acceptance of healthcare professionals' vulnerability and their support needs within the direct working environment. To create the right circumstances to meet these support needs, both healthcare professionals and hospital organizations have to recognize and take their responsibilities.

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“…A secondary objective is to determine whether or not surgeon confidence levels can be increased by the addition of virtual 3D models, which could have a positive impact on surgeon stress levels [15]. …”

Section: Introductionmentioning

confidence: 99%

Interactive virtual 3D models of renal cancer patient anatomies alter partial nephrectomy surgical planning decisions and increase surgeon confidence compared to volume-rendered images

et al. 2019

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PurposeTo determine whether the interactive visualisation of patient-specific virtual 3D models of the renal anatomy influences the pre-operative decision-making process of urological surgeons for complex renal cancer operations.MethodsFive historic renal cancer patient pre-operative computed tomography (CT) datasets were retrospectively selected based on RENAL nephrectomy score and variety of anatomy. Interactive virtual 3D models were generated for each dataset using image segmentation software and were made available for online visualisation and manipulation. Consultant urologists were invited to participate in the survey which consisted of CT and volume-rendered images (VRI) for the control arm, and CT with segmentation overlay and the virtual 3D model for the intervention arm. A questionnaire regarding anatomical structures, surgical approach, and confidence was administered.ResultsTwenty-five participants were recruited (54% response rate), with 19/25 having > 5 years of renal surgery experience. The median anatomical clarity score increased from 3 for the control to 5 for the intervention arm. A change in planned surgical approach was reported in 19% of cases. Virtual 3D models increased surgeon confidence in the surgical decisions in 4/5 patient datasets. There was a statistically significant improvement in surgeon opinion of the potential utility for decision-making purposes of virtual 3D models as compared to VRI at the multidisciplinary team meeting, theatre planning, and intra-operative stages.ConclusionThe use of pre-operative interactive virtual 3D models for surgery planning influences surgical decision-making. Further studies are needed to investigate if the use of these models changes renal cancer surgery outcomes.Electronic supplementary materialThe online version of this article (10.1007/s11548-019-01913-5) contains supplementary material, which is available to authorized users.

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The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons' Attitude (BISA) Study

Cited by 130 publications

References 24 publications

Surgeon Burnout: Defining, Identifying, and Addressing the New Reality

Surgeon Burnout: Defining, Identifying, and Addressing the New Reality

The need and availability of support systems for physicians involved in a serious adverse event

Interactive virtual 3D models of renal cancer patient anatomies alter partial nephrectomy surgical planning decisions and increase surgeon confidence compared to volume-rendered images

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