Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul 9;9(7):e029923.
doi: 10.1136/bmjopen-2019-029923.

Duration of Second Victim Symptoms in the Aftermath of a Patient Safety Incident and Association With the Level of Patient Harm: A Cross-Sectional Study in the Netherlands

Collaborators, Affiliations
Free PMC article

Duration of Second Victim Symptoms in the Aftermath of a Patient Safety Incident and Association With the Level of Patient Harm: A Cross-Sectional Study in the Netherlands

Kris Vanhaecht et al. BMJ Open. .
Free PMC article


Objectives: To describe healthcare providers' symptoms evoked by patient safety incidents (PSIs), the duration of these symptoms and the association with the degree of patient harm caused by the incident.

Design: Cross-sectional survey.

Setting: 32 Dutch hospitals that participate in the 'Peer Support Collaborative'.

Participants: 4369 healthcare providers (1619 doctors and 2750 nurses) involved in a PSI at any time during their career.

Interventions: All doctors and nurses working in direct patient care in the 32 participating hospitals were invited via email to participate in an online survey.

Primary and secondary outcome measures: Prevalence of symptoms, symptom duration and its relationship with the degree of patient harm.

Results: In total 4369 respondents were involved in a PSI and completely filled in the questionnaire. Of these, 462 reported having been involved in a PSI with permanent harm or death during the last 6 months. This had a personal, professional impact as well as impact on effective teamwork requirements. The impact of a PSI increased when the degree of patient harm was more severe. The most common symptom was hypervigilance (53.0%). The three most common symptoms related to teamwork were having doubts about knowledge and skill (27.0%), feeling unable to provide quality care (15.6%) and feeling uncomfortable within the team (15.5%). PSI with permanent harm or death was related to eightfold higher likelihood of provider-related symptoms lasting for more than 1 month and ninefold lasting longer than 6 months compared with symptoms reported when the PSI caused no harm.

Conclusion: The impact of PSI remains an underestimated problem. The higher the degree of harm, the longer the symptoms last. Future studies should evaluate how these data can be integrated in evidence-based support systems.

Keywords: health personnel/psychology; hospitals; patient safety; peer support; stress, psychological.

Conflict of interest statement

Competing interests: None declared.


Figure 1
Figure 1
Symptoms in the aftermath of PSI. PSI, patient safety incident.

Similar articles

See all similar articles

Cited by 1 article

  • Responding to adverse patient safety events in Viet Nam.
    Harrison R, Sharma A, Walton M, Esguerra E, Onobrakpor S, Nghia BT, Chinh ND. Harrison R, et al. BMC Health Serv Res. 2019 Sep 18;19(1):677. doi: 10.1186/s12913-019-4518-y. BMC Health Serv Res. 2019. PMID: 31533699 Free PMC article.


    1. Classen DC, Resar R, Griffin F, et al. ’Global trigger tool' shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff 2011;30:581–9. 10.1377/hlthaff.2011.0190 - DOI - PubMed
    1. de Vries EN, Ramrattan MA, Smorenburg SM, et al. The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care 2008;17:216-23 10.1136/qshc.2007.023622 - DOI - PMC - PubMed
    1. Wu AW, Aw W. Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ 2000;320:726–7. 10.1136/bmj.320.7237.726 - DOI - PMC - PubMed
    1. Clarkson MD, Haskell H, Hemmelgarn C, et al. Abandon the term “second victim”. BMJ 2019;364:l1233 10.1136/bmj.l1233 - DOI - PubMed
    1. Conway J, Federico F, Stewart K, et al. Respectful management of serious clinical adverse events. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement, 2011. Available on

Publication types

LinkOut - more resources