Project summary

Background and methods

A lot of research has been recently instigated on how to design safer healthcare systems in order to reduce the numbers of adverse events. However, less attention has been given to date on the amelioration of adverse outcomes or injuries aspect of patient safety which refers to “the need to care for injured patients and to support the staff involved” (Vincent, 2006).  

Patients and relatives may suffer both psychically and psychologically from medically induced injuries. There is very little research on the aftermath of serious medical incidents, but early findings from surgery suggest a wide range of psychological outcomes related with the experience of surgical adverse events such as higher levels of distress than people who had experienced serious accidents or bereavements, reported pain levels comparable, over a year after surgery, to untreated postoperative pain, and psychosocial adjustment worse than in patients with serious medical conditions (Pinto et al., BMJ Open 2016). Further trauma can be induced to patients harmed by their treatment when the incident is not handled sensitively.  

Healthcare staff may also experience severe consequences when they are involved in serious medical incidents. A few early studies have shown profound emotional effects for doctors who are involved in adverse events such as fear, guilt, anger, embarrassment, humiliation or even anxiety and depression symptoms (Pinto et al., BJS 2013 and Pinto et al., AJS 2014). 

This programme of work explores the aftermath of serious medical incidents for patients and healthcare professionals in the context of specific psychosocial theoretical frameworks (e.g. stress and coping, trauma exposure, social support). Answering the following research questions is the focus of this work.

 

Aims

• To investigate the consequences of serious medical incidents on patients and how patients cope with such incidents.
• To investigate the consequences of serious medical incidents on healthcare staff and how staff cope with such incidents.
• To investigate optimal pathways of managing serious medical incidents to improve outcomes for patients and staff.

 

Recent Results

A portfolio study involving 29 hospital sites explored the aftermath of serious medical incidents for patients and healthcare professionals in the context of defined psychosocial frameworks (e.g. stress and coping, trauma exposure and social support). This study, funded by the National Institute for Health Research (NIHR), was the first of its kind in the UK, and it relied on systematic reviews, interviews, and surveys to understand the consequences of serious medical incidents on both patients and healthcare staff.

Longitudinal data was collected from 961 patients at several time points up to one year after discharge from hospital. We found that 1 in 3 patients suffered from a complication which significantly affected their wellbeing. It was noted that coping strategies, such as social and staff support, were important in moderating or ameliorating the impact of these complications.

We are now using these findings to develop recommendations for clinicians and guidance on coping for patients and carers with the goal of improving wellbeing following a complication. Once finalised, these recommendations and guidance will be made available for dissemination across England and Wales by NHS Improvement so that if an error does occur, the aftermath can be contained and managed with minimal consequence.

 

Outputs

1. Pinto A, Faiz O, Bicknell C, et al., 2013, Surgical complications and their implications for surgeons' well-being, British Journal of Surgery, Vol:100, ISSN:0007-1323, Pages:1748-1755
2. Pinto A, Faiz O, Bicknell C, et al., 2014, Acute traumatic stress among surgeons after major surgical complications, American Journal of Surgery, Vol:208, ISSN:0002-9610, Pages:642-647
3. Pinto A, Faiz O, Davis R, et al., 2016, Surgical complications and their impact on patients' psychosocial well-being: a systematic review and meta-analysis, Bmj Open, Vol:6, ISSN:2044-6055