title: The aftermath of adverse events in Spanish primary care and hospital health professionals.
abstract: BACKGROUND
  Adverse events (AEs) cause harm in patients and disturbance for the professionals involved in the event (second victims). This study assessed the impact of AEs in primary care (PC) and hospitals in Spain on second victims.
  
  
  METHODS
  A cross-sectional study was conducted. We carried out a survey based on a random sample of doctors and nurses from PC and hospital settings in Spain. A total of 1087 health professionals responded, 610 from PC and 477 from hospitals.
  
  
  RESULTS
  A total of 430 health professionals (39.6%) had informed a patient of an error. Reporting to patients was carried out by those with the strongest safety culture (Odds Ratio -OR- 1.1, 95% Confidence Interval -CI- 1.0-1.2), nurses (OR 1.9, 95% CI 1.5-2.3), those under 50 years of age (OR 0.7, 95% CI 0.6-0.9) and primary care staff (OR 0.6, 95% CI 0.5-0.9). A total of 381 (62.5%, 95% CI 59-66%) and 346 (72.5%, IC95% 69-77%) primary care and hospital health professionals, respectively, reported having gone through the second-victim experience, either directly or through a colleague, in the previous 5 years. The emotional responses were: feelings of guilt (521, 58.8%), anxiety (426, 49.6%), re-living the event (360, 42.2%), tiredness (341, 39.4%), insomnia (317, 38.0%) and persistent feelings of insecurity (284, 32.8%). In doctors, the most common responses were: feelings of guilt (OR 0.7 IC95% 0.6-0.8), re-living the event (OR 0.7, IC95% o.6-0.8), and anxiety (OR 0.8, IC95% 0.6-0.9), while nurses showed greater solidarity in terms of supporting the second victim, in both PC (p = 0.019) and hospital (p = 0.019) settings.
  
  
  CONCLUSIONS
  Adverse events cause guilt, anxiety, and loss of confidence in health professionals. Most are involved in such events as second victims at least once in their careers. They rarely receive any training or education on coping strategies for this phenomenon.
authors.affiliation: Departamento de Salud Alicante-Sant Joan, Alicante, Spain. jose.mira@umh.es.|Universidad Miguel Hernández, Elche, Spain. jose.mira@umh.es.
authors.forename: José Joaquín
authors.initials: JJ
authors.lastname: Mira
authors.affiliation: Universidad Miguel Hernández, Elche, Spain. icarrillo@umh.es.
authors.forename: Irene
authors.initials: I
authors.lastname: Carrillo
authors.affiliation: Hospital Universitario Fundación Alcorcón, Madrid, Spain. slorenzo@fhalcorcon.es.
authors.forename: Susana
authors.initials: S
authors.lastname: Lorenzo
authors.affiliation: Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, Spain. lena.ferrus@sanitatintegral.org.
authors.forename: Lena
authors.initials: L
authors.lastname: Ferrús
authors.affiliation: Atención Primaria Comarca Donostia, Donostia, Spain. carmen.silvestrebustos@osakidetza.net.
authors.forename: Carmen
authors.initials: C
authors.lastname: Silvestre
authors.affiliation: Observatorio para la Calidad del Sistema Sanitario en Andalucía, Sevilla, Spain. pastora.perez.perez@juntadeandalucia.es.
authors.forename: Pastora
authors.initials: P
authors.lastname: Pérez-Pérez
authors.affiliation: Servicio Madrileño de Salud, Madrid, Spain. guadalupe.olivera@salud.madrid.org.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Olivera
authors.affiliation: Castilla La Mancha Health Service (SESCAM), Toledo, Spain. figlesias@jccm.es.
authors.forename: Fuencisla
authors.initials: F
authors.lastname: Iglesias
authors.affiliation: Hospital Universitario Donostia, Donostia, Spain. elena.zavalaaizpurua@osakidetza.net.
authors.forename: Elena
authors.initials: E
authors.lastname: Zavala
authors.affiliation: Gerencia de Atención Primaria de Salamanca, Castilla y León Health Service (SACYL), Salamanca, Spain. jmaderuelo@saludcastillayleon.es.
authors.forename: José Ángel
authors.initials: JÁ
authors.lastname: Maderuelo-Fernández
authors.affiliation: Universidad Miguel Hernández, Elche, Spain. vitaller_jul@gva.es.|Inspección Médica, Elche, Spain. vitaller_jul@gva.es.
authors.forename: Julián
authors.initials: J
authors.lastname: Vitaller
authors.affiliation: Basque Institute for Healthcare Innovation (O + Berri), Bilbao, Spain. nuno@bioef.org.
authors.forename: Roberto
authors.initials: R
authors.lastname: Nuño-Solinís
authors.affiliation: Medicina de Familia y Comunitaria, Centro de Salud Caspe, Sector Alcañiz, Aragon Health Service (SALUD), Zaragoza, Spain. mpastier@gmail.com.
authors.forename: Pilar
authors.initials: P
authors.lastname: Astier
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000523:psychology*; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards*; D013030:Spain; D013315:Stress, Psychological; D011795:Surveys and Questionnaires