Adverse events within health care settings can lead to two victims. The first victim is the patient and family and the second victim is the involved health care professional. The latter is the focus of this review. The objectives are to determine definitions of this concept, research the prevalence and the impact of the adverse event on the second victim, and the used coping strategies. Therefore a literature research was performed by using a three-step search procedure. A total of 32 research articles and 9 nonresearch articles were identified. The second victim phenomenon was first described by Wu in 2000. In 2009, Scott et al. introduced a detailed definition of second victims. The prevalence of second victims after an adverse event varied from 10.4% up to 43.3%. Common reactions can be emotional, cognitive, and behavioral. The coping strategies used by second victims have an impact on their patients, colleagues, and themselves. After the adverse event, defensive as well as constructive changes have been reported in practice. The second victim phenomenon has a significant impact on clinicians, colleagues, and subsequent patients. Because of this broad impact it is important to offer support for second victims. When an adverse event occurs, it is critical that support networks are in place to protect both the patient and involved health care providers.

Ten years ago,

Background One out of seven patients is involved in an adverse event. The first priority after such an

We articulate an intellectual history and a definition, description and model of patient safety. We define patient safety as a discipline in the health care professions that applies safety science methods toward the goal of achieving a trustworthy system of health care delivery. We also define patient safety as an attribute of health care systems that minimizes the incidence and impact of adverse events and maximizes recovery from such events. Our description includes: why the field of patient safety exists (the high prevalence of avoidable adverse events); its nature; its essential focus of action (the microsystem); how patient safety works (e.g., high-reliability design, use of safety sciences, methods for causing change, including cultural change); and who its practitioners are (i.e., all health care workers, patients and advocates). Our simple and overarching model identifies four domains of patient safety (recipients of care, providers, therapeutics and methods) and the elements that fall within the domains. Eleven of these elements are described in this paper.

Potential solutions include health worker education coupled with incentives to embed policy into practice, better communication about approaches beyond the punitive, legislation that allows both disclosure to patients and quality improvement protection for institutions, apology protection for providers, comprehensive disclosure programs that include patient compensation, delinking of patient compensation from regulatory scrutiny of disclosing physicians, legal and contractual requirements for disclosure, and better measurement of its occurrence and quality. A longer-term solution involves educating the public and health care workers about patient safety.

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s o u n d i n g b o a r d T h e ne w e ngl a nd jou r na l o f m e dicine n engl j med 369;18 nejm.org october 31, 2013You are a young neurologist practicing in a small hospital. You admit a 55-year-old woman with hypertension and type 2 diabetes mellitus who had an embolic stroke at home. On reviewing the patient's medical record, you notice that she appears to have been in atrial fibrillation during two electrocardiographic (ECG) tests during visits to the office of her primary care physician (PCP) for palpitations. Her PCP, an internist who provides many of your referrals, read both ECGs as normal and attributed her palpitations to "probable mitral-valve prolapse and anxiety." The patient is currently in normal sinus rhythm. You show the internist the ECGs and express concern that they indicate atrial fibrillation. He politely disagrees and says you are confused by noise from his old ECG machine.

Traditionally, anaesthetists in Canada have had no opportunity to visit their patients before hospital admission. As a result, patients with more complex medical problems are often admitted in advance of their scheduled date of operation to allow thorough preoperative evaluation and preparation, thus creating considerable inconvenience for the patients and additional expense for the health care system. As well, in recent years, there has been a strong shift towards increased use of ambulatory surgery facilities, and a trend towards acceptance of more medically ill patients in these centres. Thus, more patients are presenting for anaesthesia and surgery in these ambulatory facilities without formal preoperative anaesthetic assessment. We believe that these factors have combined to result in an increasingly large number of surgical delays and cancellations and thus represent a considerable impediment to the efficient use of hospital beds and operating room time.These problems may be resolved if anaesthetists are able to assess higher-risk patients on an ambulatory preadmission basis before surgery. Although initially proposed over 40 yr ago, t a review of the medical literatare showed that there was very little information on the organization, effectiveness and utilization of the preadmission anaesthesia consultation clinic. 2-5 Therefore, we studied the case referral pattern, operative delay and cancellation rates for patients seen in our newly established preadmission anaesthesia consultation clinic. MethodsThe preadmission anaesthesia consultation clinic was established at Toronto Western Division, Toronto Hospital in September 1990. This hospital provides tertiary care to patients in general surgery, orthopaedic surgery, urology, ophthalmology, otolaryngology and neurosur-CAN J ANAESTH 1992 t 39:l0 / pp 1051-7