title: Interventions in health organisations to reduce the impact of adverse events in second and third victims.
abstract: BACKGROUND
  Adverse events (AE) are also the cause of suffering in health professionals involved. This study was designed to identify and analyse organization-level strategies adopted in both primary care and hospitals in Spain to address the impact of serious AE on second and third victims.
  
  
  METHODS
  A cross-sectional study was conducted in healthcare organizations assessing: safety culture; health organization crisis management plans for serious AE; actions planned to ensure transparency in communication with patients (and relatives) who experience an AE; support for second victims; and protective measures to safeguard the institution's reputation (the third victim).
  
  
  RESULTS
  A total of 406 managers and patient safety coordinators replied to the survey. Deficient provision of support for second victims was acknowledged by 71 and 61% of the participants from hospitals and primary care respectively; these respondents reported there was no support protocol for second victims in place in their organizations. Regarding third victim initiatives, 35% of hospital and 43% of primary care professionals indicated no crisis management plan for serious AE existed in their organization, and in the case of primary care, there was no crisis committee in 34% of cases. The degree of implementation of second and third victim support interventions was perceived to be greater in hospitals (mean 14.1, SD 3.5) than in primary care (mean 11.8, SD 3.1) (p < 0.001).
  
  
  CONCLUSIONS
  Many Spanish health organizations do not have a second and third victim support or a crisis management plan in place to respond to serious AEs.
authors: Departamento de Salud Alicante-Sant Joan, Alicante, Spain. jose.mira@umh.es.|Universidad Miguel Hernández, Altamira Building, Avd Universidad s/n, 03202, Elche, Spain. jose.mira@umh.es.
authors: José Joaquín
authors: JJ
authors: Mira
authors: Hospital Universitario Fundación Alcorcón, Madrid, Spain. slorenzo@fhalcorcon.es.
authors: Susana
authors: S
authors: Lorenzo
authors: Universidad Miguel Hernández, Altamira Building, Avd Universidad s/n, 03202, Elche, Spain. icarrillo@umh.es.
authors: Irene
authors: I
authors: Carrillo
authors: Consorcio Sanitario Integral, L'Hospitalet de Llobregat, Barcelona, Spain. lena.ferrus@sanitatintegral.org.
authors: Lena
authors: L
authors: Ferrús
authors: Observatorio para la Seguridad del Paciente, Agencia de Calidad Sanitaria de Andalucía, Sevilla, Spain. pastora.perez.perez@juntadeandalucia.es.
authors: Pastora
authors: P
authors: Pérez-Pérez
authors: Servicio de Salud de Castilla La Mancha (SESCAM), Toledo, Spain. figlesias@jccm.es.
authors: Fuencisla
authors: F
authors: Iglesias
authors: Atención Primaria Comarca Donostia, Donostia, Spain. mariacarmen.silvestrebusto@osakidetza.net.
authors: Carmen
authors: C
authors: Silvestre
authors: Servicio Madrileño de Salud, Madrid, Spain. guadalupe.olivera@salud.madrid.org.
authors: Guadalupe
authors: G
authors: Olivera
authors: Hospital Universitario Donostia, Donostia, Spain. elena.zavalaaizpurua@osakidetza.net.
authors: Elena
authors: E
authors: Zavala
authors: Instituto Vasco de Innovación Sanitaria (O+berri), Barakaldo, Spain. nuno@bioef.org.
authors: Roberto
authors: R
authors: Nuño-Solinís
authors: Gerencia de Atención Primaria de Salamanca. Castilla y León Health Service (SACYL), Salamanca, Spain. jmaderuelo@saludcastillayleon.es.
authors: José Ángel
authors: JÁ
authors: Maderuelo-Fernández
authors: Universidad Miguel Hernández, Altamira Building, Avd Universidad s/n, 03202, Elche, Spain. vitaller_jul@gva.es.|Inspección Médica, Elche, Spain. vitaller_jul@gva.es.
authors: Julián
authors: J
authors: Vitaller
authors: Medicina de Familia y Comunitaria, Centro de Salud Caspe, Sector Alcañiz, Servicio Aragonés de Salud (SALUD), Zaragoza, Spain. mpastier@gmail.com.
authors: Pilar
authors: P
authors: Astier
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology*; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D019300:Medical Errors / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D015279:Organizational Culture; D061214:Patient Safety; D011320:Primary Health Care; D013030:Spain; D011795:Surveys and Questionnaires