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Acute traumatic stress among surgeons after major surgical complications

      Highlights

      • Patient harm resulting from medical treatment can be traumatic for healthcare staff
      • Many surgeons reported traumatic stress of clinical concern after their most recent major complication
      • Self-distraction and being a general surgeon predicted traumatic stress of clinical concern

      Abstract

      Background

      Patient harm resulting from medical treatment may be a traumatic experience for health care staff. This study examined surgeons' levels of traumatic stress in the aftermath of the most recent major complication that happened in their patients' care and its relationship with surgeons' coping strategies, causal attributions, and perceived institutional culture around surgical complications.

      Methods

      Forty-seven general and vascular surgeons from 3 National Health Service Trusts in London, UK completed a questionnaire assessing the aforementioned variables (64.4% response rate).

      Results

      One-third of the participants reported traumatic stress of clinical concern 1 month after the incident. The use of self-distraction (P < .05) and being a general surgeon (P < .05) were predictive of traumatic stress of clinical concern in multiple logistic regression analysis.

      Conclusions

      Some surgeons may experience acute traumatic stress after serious surgical complications. The extent to which this is of clinical concern is associated with their use of self-distraction as well as the clinical setting. Health care organizations need to attend to surgeons' psychological needs in the aftermath of serious adverse events.

      Keywords

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      References

        • Aranaz-Andrés J.M.
        • Aibar-Remón C.
        • Vitaller-Murillo J.
        • et al.
        Incidence of adverse events related to health care in Spain: results of the Spanish National Study of Adverse Events.
        J Epidemiol Commun H. 2008; 62: 1022-1029
        • Baker G.R.
        The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada.
        Can Med Assoc J. 2004; 170: 1678-1686
        • Brennan T.A.
        • Leape L.L.
        • Laird N.M.
        • et al.
        Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study I.
        Qual Saf Health Care. 2004; 13: 145-151
        • Davis P.
        • Lay-Yee R.
        • Briant R.
        • et al.
        Adverse events in New Zealand public hospitals: principal findings from a national survey. HINZ.
        Health Informatics Society of Australia; Royal Australian College of General Practitioners, Brunswick East, Vic.2003: 522-543
        • Leape L.L.
        • Brennan T.A.
        • Laird N.
        • et al.
        The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II.
        NEJM. 1991; 324: 377-384
        • Michel P.
        • Quenon J.L.
        • Djihoud A.
        • et al.
        French national survey of inpatient adverse events prospectively assessed with ward staff.
        Qual Saf Health Care. 2007; 16: 369-377
        • Schiøler T.
        • Lipczak H.
        • Pedersen B.L.
        • et al.
        • Danish adverse event study
        Incidence of adverse events in hospitals. A retrospective study of medical records.
        Ugeskrift for Laeger. 2001; 163: 5370-5378
        • Soop M.
        • Fryksmark U.
        • Köster M.
        • et al.
        The incidence of adverse events in Swedish hospitals: a retrospective medical record review study.
        Int J Qual Health Care. 2009; 21: 285-291
        • Vincent C.
        • Neale G.
        • Woloshynowych M.
        Adverse events in British hospitals: preliminary retrospective record review.
        BMJ. 2001; 322: 517-519
        • Wilson R.M.
        The quality in Australian health care study.
        MJA. 1995; 163: 458-471
        • Zegers M.
        • de Bruijne M.C.
        • Wagner C.
        • et al.
        Adverse events and potentially preventable deaths in Dutch hospitals: results of a retrospective patient record review study.
        Qual Saf Health Care. 2009; 18: 297-302
        • Vincent C.
        Patient Safety.
        Wiley Blackwell, London2010
        • Wu A.W.
        Medical error: the second victim.
        BMJ. 2000; 320: 726-727
        • Aasland O.G.
        • Forde R.
        Impact of feeling responsible for adverse events on doctors' personal and professional lives: the importance of being open to criticism from colleagues.
        Qual Saf Health Care. 2005; 14: 13-17
        • Christensen J.F.
        • Levinson W.
        • Dunn P.M.
        The heart of darkness: the impact of perceived mistakes on physicians.
        J Gen Intern Med. 1992; 7: 424-431
        • White A.A.
        • Waterman A.D.
        • McCotter P.
        • et al.
        Supporting health care workers after medical error: considerations for health care leaders.
        J Clin Outcomes Manag. 2008; 15: 240-247
        • Wu A.W.
        • Folkman S.
        • McPhee S.J.
        • et al.
        Do house officers learn from their mistakes?.
        The JAMA. 1991; 265: 2089-2094
        • Leape L.L.
        A systems analysis approach to medical error.
        J Eval Clin Pract. 1997; 3: 213-222
        • Gawande A.A.
        • Thomas E.J.
        • Zinner M.J.
        • et al.
        The incidence and nature of surgical adverse events in Colorado and Utah in 1992.
        Surgery. 1999; 126: 66-75
        • Shanafelt T.D.
        Burnout and medical errors among American surgeons.
        Ann Surg. 2010; 251: 995-1000
        • Green B.L.
        Defining trauma: terminology and generic stressor dimensions.
        J Appl Soc Psychol. 1990; 20: 1632-1642
        • Pinto A.
        • Faiz O.
        • Bicknell C.
        • et al.
        Surgical complications and their implications for surgeons' well-being.
        Br J Surg. 2013; 100: 1748-1755
        • Brewin C.R.
        • Andrews B.
        • Rose S.
        Diagnostic overlap between acute stress disorder and PTSD in victims of violent crime.
        Am J Psychiatry. 2003; 160: 783-785
        • Yehuda R.
        Post-traumatic stress disorder.
        NEJM. 2002; 346: 108-114
        • Sirriyeh R.
        • Lawton R.
        • Gardner P.
        • et al.
        Coping with medical error: a systematic review of papers to assess the effects of involvement in medical errors on healthcare professionals' psychological well-being.
        Qual Saf Health Care. 2010; 19: 1-8
        • Joseph S.
        • Yule W.
        • Williams R.
        Post-traumatic stress: attributional aspects.
        J Trauma Stress. 1993; 6: 501-513
        • Joseph S.A.
        • Brewin C.R.
        • Yule W.
        • et al.
        Causal attributions and psychiatric symptoms in survivors of the Herald of Free Enterprise disaster.
        Br J Psychiatry. 1991; 159: 542-546
        • Brewin C.R.
        Psychological theories of posttraumatic stress disorder.
        Clin Psychol Rev. 2003; 23: 339-376
        • Horowitz M.
        • Wilner N.
        • Alvarez W.
        Impact of Events Scale: a measure of subjective stress.
        Psychosom Med. 1979; 41: 209-218
        • Firth J.
        • Brewin C.
        Attributions and recovery from depression: a preliminary study using cross-lagged correlation analysis.
        Br J Clin Psychol. 1982; 21: 229-230
        • Carver C.
        You want to measure coping but your protocol's too long: consider the brief Cope.
        Int J Behav Med. 1997; 4: 92-100
        • Sorra J.
        • Nieva V.F.
        Hospital Survey on Patient Safety Culture.
        Agency for Healthcare Research and Quality, Rockville, MD2004
        • Field A.
        Discovering Statistics Using SPSS.
        3rd ed. Sage, London2011
        • Clohessy S.
        • Ehlers A.
        PTSD symptoms, response to intrusive memories and coping in ambulance service workers.
        Br J Clin Psychol. 1999; 38: 251-265
        • Ehlers A.
        • Clark D.M.
        A cognitive model of posttraumatic stress disorder.
        Behav Res Ther. 2000; 38: 319-345
        • Schwappach D.L.
        • Boluarte T.A.
        The emotional impact of medical error involvement on physicians: a call for leadership and organisational accountability.
        Swiss Med Wkly. 2009; 139: 9-15
        • Engel K.G.
        • Rosenthal M.
        • Sutcliffe K.M.
        • et al.
        Residents' responses to medical error: coping, learning, and change.
        Acad Med. 2006; 81: 86-93

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