Systematic review of psychological, emotional and behavioural impacts of surgical incidents on operating theatre staff.

N Serou,R D Slight,C Vincent,S P Slight,K Moorthy,A K Husband,L Sahota,S P Forrest

doi:10.1002/bjs5.21

Abstract

BackgroundAdverse surgical incidents affect both patients and health professionals. This study sought to explore the effect of surgical incidents on operating theatre staff and their subsequent behaviours.MethodsEligible studies were primary research or reviews that focused on the effect of incidents on operating theatre staff in primary, secondary or tertiary care settings. MEDLINE, Embase, CINALH and PsycINFO were searched. A data extraction form was used to capture pertinent information from included studies and the Critical Appraisal Skills Programme (CASP) tool to appraise their quality. PRISMA‐P reporting guidelines were followed and the review is registered with PROSPERO.ResultsA total of 3918 articles were identified, with 667 duplicates removed and 3230 excluded at the title, abstract and full‐text stages. Of 21 included articles, eight focused on the impact of surgical incidents on surgeons and anaesthetists. Only two involved theatre nurses and theatre technicians. Five key themes emerged: the emotional impact on health professionals, organization culture and support, individual coping strategies, learning from surgical complications and recommended changes to practice.ConclusionHealth professionals suffered emotional distress and often changed their behaviour following a surgical incident. Both organizations and individual clinicians can do a great deal to support staff in the aftermath of serious incidents.

Highlights

Medical errors affect up to 16 per cent of patients admitted to hospital[1,2], with 50 per cent of these occurring when surgical or invasive procedures are performed[2]
Articles of interest included data concerning one or more of the following: professional and personal impact of a surgical incident on operating theatre staff, including psychological or emotional consequences that affected staff performance, practices and responses; safety concerns raised by staff affected by a surgical incident; and support offered to staff by their colleagues, seniors, department or organization following a surgical incident
Health professionals can suffer severe emotional distress following a surgical incident. These incidents may arise from an operation that had a poor outcome, that might reflect the severity of illness of the patient, or an error assumed to be due to the health professional concerned or a member of the wider surgical team

Summary

Introduction

Medical errors affect up to 16 per cent of patients admitted to hospital[1,2], with 50 per cent of these occurring when surgical or invasive procedures are performed[2]. A secondary victim has been defined as ‘a health care provider involved in an unanticipated adverse patient event, medical error and/or a patient related-injury who becomes victimised in the sense that the provider is traumatised by the event’[5,6] Surgical incidents are those events that occur during a surgical or invasive procedure in an operating theatre. They may or may not result in patient harm (near misses, serious adverse events), but still affect the health professionals involved. Conclusion: Health professionals suffered emotional distress and often changed their behaviour following a surgical incident Both organizations and individual clinicians can do a great deal to support staff in the aftermath of serious incidents.

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