BACKGROUND: Adverse medical events affect 10% of American households annually, inducing a variety of harms and attitudinal changes. The impact of adverse events on perceived abandonment by patients and their care partners has not been methodically assessed.
OBJECTIVE: To identify ways in which providers, patients and families responded to medical mishaps, linking these qualitatively and statistically to reported feelings of abandonment and sequelae induced by perceived abandonment.
METHODS: Mixed-methods analysis of responses to the Massachusetts Medical Errors Recontact survey with participants reporting a medical error within the past 5 years. The survey consisted of forty closed and open-ended questions examining adverse medical events and their consequences. Respondents were asked whether they felt \'that the doctors abandoned or betrayed you or your family\'. Open-ended responses were analysed with a coding schema by two clinician coders.
RESULTS: Of the 253 respondents, 34.5% initially and 20% persistently experienced abandonment. Perceived abandonment could be traced to interactions before (18%), during (34%) and after (45%) the medical mishap. Comprehensive post-incident communication reduced abandonment for patients staying with the provider associated with the mishap. However, 68.4% of patients perceiving abandonment left their original provider; for them, post-error communication did not increase the probability of resolution. Abandonment accounted for half the post-event loss of trust in clinicians.
CONCLUSIONS: Survey-based data may under-report the impact of perceived errors on vulnerable populations. Moreover, patients may not be cognizant of all forms of adverse events or all sequelae to those events. Our data were drawn from a single state and time period.
CONCLUSIONS: Addressing the deleterious impact of persisting abandonment merits attention in programmes responding to patient safety concerns. Enhancing patient engagement in the aftermath of an adverse medical event has the potential to reinforce therapeutic alliances between patients and their subsequent clinicians.

OBJECTIVE: This study aims to explore the \"second victim\" phenomenon in healthcare professions students following an adverse event.
BACKGROUND: In healthcare settings, adverse events affect not only patients but also the involved healthcare personnel, who experience a wide range of physical and psychological responses, a situation known as the second victim phenomenon. This phenomenon also extends to students in health-related professions during their clinical training, yet there needs to be more research specifically addressing this group.
METHODS: A scoping review METHODS: This scoping review was guided by Arksey and O\'Malley\'s methodological framework. In December 2023, we conducted a comprehensive database search in PubMed, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete, Web of Science (WoS), Scopus and the Virtual Health Library (VHL). The review included original research studies of any design that focused on the second victim phenomenon among students, published in English, Spanish, German or Portuguese, with no restrictions on the publication date. The review was reported according to PRISMA-ScR guidelines.
RESULTS: Seven studies were selected, primarily involving nursing and medical students. Common triggers of the second victim phenomenon in students were medication errors, patient falls and procedural errors. Described symptoms ranged from emotional distress, such as stress and hypervigilance, to physical symptoms, like sleep disturbances. Among the factors that influenced how this \"second victim\" phenomenon manifested in students were the reactions of their peers and the lack of support from supervisors. Contrary to the three possible outcomes described for professionals as second victims (surviving, thriving, or leaving), students are only described with two: giving up or moving on.
CONCLUSIONS: The studies highlighted the crucial role of peer and supervisor support in managing such difficult situations. The results suggest that additional research is necessary in other healthcare disciplines. Educational and healthcare institutions should improve their preventive and management strategies to address the phenomenon\'s impact on students.

John Tingle, Associate Professor, Birmingham Law School, University of Birmingham, discusses the state of patient safety in the NHS and several key reports.

Objectives: Patient safety incidents (PSIs) are common in healthcare. Open communication facilitated by psychological safety in healthcare could contribute to the prevention of PSIs and enhance patient safety. The aim of the study was to explore medical professionals\' responses to a PSI in relation to psychological safety in Slovak healthcare. Methods: Sixteen individual semi-structured interviews with Slovak medical professionals were performed. Obtained qualitative data were transcribed verbatim and analysed using the conventional content analysis method and the consensual qualitative research method. Results: We identified eight responses to a PSI from medical professionals themselves as well as their colleagues, many of which were active and with regard to ensuring patient safety (e.g., notification), but some of them were passive and ultimately threatening patients\' safety (e.g., silence). Five superiors\' responses to the PSI were identified, both positive (e.g., supportive) and negative (e.g., exaggerated, sharp). Conclusion: Medical professionals\' responses to a PSI are diverse, indicating a potential for enhancing psychological safety in healthcare.

Central venous access is common practice in intensive care, anesthesia and emergency departments. It is, however, a delicate technical procedure, prone to complications. We present a case report on the placement of a left jugular central venous line in the emergency room, which was thought to be a routine procedure. However, the operator observed arterial blood during sampling, and the central line was described as poorly positioned on the control X-ray. After verification and other examinations, the existence of a vertical vein was discovered in this patient, connecting the left superior pulmonary vein to the brachiocephalic trunk. A poorly positioned central venous line can therefore lead to the discovery of asympomatic congenital vascular anomalies, unrelated to the clinical context. This case study illustrates the various tools available to ensure the correct position of a central venous line, and their clinical implications.
La mise en place d’une voie veineuse centrale est de pratique courante aux soins intensifs, en anesthésie et aux urgences. Il s’agit cependant d’un acte technique relativement invasif, délicat et potentiellement sujet à complications. Nous présentons un cas clinique relatant la mise en place d’une voie veineuse centrale jugulaire gauche en salle de déchocage, manœuvre réputée banale. Cependant, l’opérateur objective visuellement du sang d’allure artérielle lors du prélèvement sanguin sur le cathéter. En outre, l’imagerie par radiographie thoracique décrit une malposition de ce dispositif. Après vérifications et examens complémentaires, nous découvrons finalement l’existence d’une veine verticale chez ce patient, reliant la veine pulmonaire supérieure gauche au tronc brachio-céphalique. Une voie veineuse centrale, apparemment mal positionnée, peut, dès lors, conduire à la découverte d’anomalies vasculaires congénitales asymptomatiques, sans lien nécessaire avec le contexte clinique sous-jacent. Ce cas clinique nous permet d’aborder les différents outils à notre disposition actuelle afin de déterminer le positionnement adéquat d’une voie veineuse centrale et les implications cliniques qui en découlent.

This study examined health information technology-related incidents to characterise system issues as a basis for improvement in Swedish clinical practice. Incident reports were collected through interviews together with retrospectively collected incidents from voluntary incident databases, which were analysed using deductive and inductive approaches. Most themes pertained to system issues, such as functionality, design, and integration. Identified system issues were dominated by technical factors (74%), while human factors accounted for 26%. Over half of the incidents (55%) impacted on staff or the organisation, and the rest on patients - patient inconvenience (25%) and patient harm (20%). The findings indicate that it is vital to choose and commission suitable systems, design out \"error-prone\" features, ensure contingency plans are in place, implement clinical decision-support systems, and respond to incidents on time. Such strategies would improve the health information technology systems and Swedish clinical practice.

UNASSIGNED: Residents must prepare for effective communication with patients after medical errors. The video-based communication assessment (VCA) is software that plays video of a patient scenario, asks the physician to record what they would say, engages crowdsourced laypeople to rate audio recordings of physician responses, and presents feedback to physicians.
UNASSIGNED: To evaluate the effectiveness of VCA feedback in resident error disclosure skill training.
UNASSIGNED: This single-blinded, randomized clinical trial was conducted from July 2022 to May 2023 at 7 US internal medicine and family medicine residencies (10 total sites). Participants were second-year residents attending required teaching conferences. Data analysis was performed from July to December 2023.
UNASSIGNED: Residents completed 2 VCA cases at time 1 and were randomized to the intervention, an individual feedback report provided in the VCA application after 2 weeks, or to control, in which feedback was not provided until after time 2. Residents completed 2 additional VCA cases after 4 weeks (time 2).
UNASSIGNED: Panels of crowdsourced laypeople rated recordings of residents disclosing simulated medical errors to create scores on a 5-point scale. Reports included learning points derived from layperson comments. Mean time 2 ratings were compared to test the hypothesis that residents who had access to feedback on their time 1 performance would score higher at time 2 than those without feedback access. Residents were surveyed about demographic characteristics, disclosure experience, and feedback use. The intervention\'s effect was examined using analysis of covariance.
UNASSIGNED: A total of 146 residents (87 [60.0%] aged 25-29 years; 60 female [41.0%]) completed the time 1 VCA, and 103 (70.5%) completed the time 2 VCA (53 randomized to intervention and 50 randomized to control); of those, 28 (54.9%) reported reviewing their feedback. Analysis of covariance found a significant main effect of feedback between intervention and control groups at time 2 (mean [SD] score, 3.26 [0.45] vs 3.14 [0.39]; difference, 0.12; 95% CI, 0.08-0.48; P = .01). In post hoc comparisons restricted to residents without prior disclosure experience, intervention residents scored higher than those in the control group at time 2 (mean [SD] score, 3.33 [0.43] vs 3.09 [0.44]; difference, 0.24; 95% CI, 0.01-0.48; P = .007). Worse performance at time 1 was associated with increased likelihood of dropping out before time 2 (odds ratio, 2.89; 95% CI, 1.06-7.84; P = .04).
UNASSIGNED: In this randomized clinical trial, self-directed review of crowdsourced feedback was associated with higher ratings of internal medicine and family medicine residents\' error disclosure skill, particularly for those without real-life error disclosure experience, suggesting that such feedback may be an effective way for residency programs to address their requirement to prepare trainees for communicating with patients after medical harm.
UNASSIGNED: ClinicalTrials.gov Identifier: NCT06234085.

UNASSIGNED: In the healthcare system, in the last 30 years, the prognostically negative value of the so-called Weekend Effect (WE) has been internationally recognized. The WE is regarded as the increased risk a patient might incur when hospitalized during non-working days, of enduring severe complications in comparison to the same hospitalization that occur on working days. The aim of this study was to retrospectively verify whether, once a mistake was made during weekends or on holidays, in comparison to a mistake occurred on workdays, it subsequently implied a higher risk of complications, death included, in a statistical and medico-legal way.
UNASSIGNED: Three different evaluators independently examined a total of 378 medico-legal cases over a more than 20-year period. Eventual medical actions and omissions were labelled as \'mistake\' when the AJ claimed that at least one occurred; \'alleged mistake\' included the cases where the EW\'s report disagreed with the AJ\'s one; finally, \'no mistake\' when both the AJ and the EW agreed in their evaluations. During weekends there is a higher risk that a mistake occurs (OR=3.3, 95% CI=1.6;7.4; p-value<0.001) compared to weekdays. When death occurs, delayed diagnosis is the main cause (p=0.02), whereas a damaging action is more frequently claimed in general.
UNASSIGNED: We verified as actual the impact of the WE on patients\' outcome from a medico-legal point of view. The implications for an improvement of the several settings of the Italian NHS are various, and many are the consequences in the healthcare management.

BACKGROUND: Diagnostic excellence refers to the optimal process to attain an accurate and precise explanation about a patient\'s condition and incorporates the perspectives of patients and their care partners. Patient-reported measures (PRMs), designed to capture patient-reported information, have potential to contribute to achieving diagnostic excellence. We aimed to craft a set of roadmaps illustrating goals and guiding the development of PRMs for diagnostic excellence (\"Roadmaps\").
METHODS: We used iterative inputs from environmental literature scans, expert consultations, and patient voice and employed human-centred design (HCD) and equity-focused road-mapping. The culminating activity of these approaches was an Expert Convening.
RESULTS: Use of PRMs can achieve multiple goals for diagnostic excellence, including but not limited to: (1) PRMs for diagnostic continuity, (2) diagnostic PRM alerts, (3) PRM-based quality improvement, (4) PRMs for research, (5) PRMs for routine screening, (6) PRM-based diagnostic excellence population-level patterns, and (7) PRMs supporting patient storytelling. Equity is considered as a cross-cutting goal. Altogether these and future goals support operationalising a vision of patient-reported diagnostic excellence. Roadmaps were developed as a dynamic tool to illustrate PRMs in relation to specific steps with feedback loops to accomplish goals, anticipated timeframes (8-15 years), synergies to foster, and challenges to overcome. Roadmaps are practical in their following PRMs through the stages of development, endorsement, implementation and scaling, and acting upon those measures. Timeframe estimates assume immediate transitions between these stages and no acceleration through incentives and active coordination.
CONCLUSIONS: PRMs for diagnostic excellence have potential to connect patient perspectives, equity, and achievable goals. Roadmaps offer a design approach to enable coordinating measurement activities among diverse stakeholders. Roadmaps also highlight versatility in ways patient-reported information can be collected and used, from clinical settings to public health contexts. Patient-reported diagnostic excellence cannot be established as a solely top-down endeavour, but inherently benefits from bottom-up approaches.

OBJECTIVE: The aim of the current research is to determine nursing students\' levels of altruism, attitudes towards medical errors and the effect of altruism on attitudes towards medical errors.
BACKGROUND: Nursing students should be aware of medical errors and have an attitude towards correcting them. Professional values play an essential role in changing, shaping and developing attitudes in nursing students. Altruism is one of the most important determining professional values in students\' professional success and development of attitudes towards different situations.
UNASSIGNED: This study is a descriptive and cross-sectional study.
METHODS: The research was conducted in the Nursing Department of a state university in Turkey and the study population consisted of 2nd, 3rd and 4th year nursing students (N=375) who were continuing their education and clinical practice in the spring semester of the 2022-2023 academic year. The study was completed with 321 students. The data were collected online using the information form, the Altruism Scale and the Scale of Attitudes Towards Medical Errors via Google Forms between 01 and 31 May 2023. Data were analysed using descriptive statistics, Independent-Samples t-test, One-Way ANOVA test, Pearson\'s correlation analysis and simple linear regression.
RESULTS: Students had a mean score of 69.68 (range 40-98) on the Altruism Scale and 3.82 (range 2.38-4.56) on the Scale of Attitudes Towards Medical Errors. A significant, very weak positive correlation was found between the Altruism Scale and the total mean scores of the Attitudes Towards Medical Errors Scale (p=0.001). Altruism was found to have a significant effect on attitude towards medical errors (p=0.001). The explanatory power of the regression model was 0.101 and altruism explained 10.1 % of the students\' attitudes towards medical errors scores.
CONCLUSIONS: Students have positive attitudes towards medical errors, high awareness of the importance of medical errors and error reporting and above average levels of altruism. Altruism has a positive effect on attitudes towards medical errors.