Support Methods for Healthcare Professionals Who Are Second Victims: An Integrative Review.

A second victim is a healthcare provider who has been involved in a critical event. A critical event is a clinical situation in which an unforeseen clinical outcome occurs, or the clinical deterioration of the patient takes place for many different reasons. The patient and his/her family are the first victims. The healthcare provider(s) involved in the event are second victims. After such an event, the healthcare provider may experience a constellation of negative emotions, such as guilt, sadness, depression, somatic symptoms, hypervigilance, and fear. Most second victims require support to cope with the adverse clinical situation. Many of the studies addressed in this integrative review, revealed that having a trusted colleague or staff member with whom to discuss the critical event is therapeutic. Some organizations have developed programs to support second victims in which specially trained staff members are deployed to discuss critical events with those involved, if the participant(s) desire the support. Other clinical facilities do not have established support programs; however, healthcare providers have expressed desire to discuss the critical event with supportive colleagues.

Cost Analysis of Intravenous Propofol Monotherapy versus Intravenous Combination Sedation in Patients Undergoing Outpatient Gastrointestinal Endoscopy.

In outpatient gastrointestinal (GI) endoscopy, for which postanesthesia care unit (PACU) stays are expected to be brief, sedative choices by anesthesia providers can affect costs. The purpose of this project was to evaluate the cost of propofol monotherapy compared with combination sedation consisting of propofol with any of the following: midazolam, fentanyl, dexmedetomidine, and/or ketamine. A total of 277 patients who underwent outpatient GI endoscopy were included in this retrospective medical record review. Patients were separated into 2 groups: propofol monotherapy (n = 233) or combination sedation (n = 44). Outcomes included PACU length of stay, episodes of postoperative nausea and vomiting (PONV), PACU costs, and medication costs. The average PACU length of stay was 35.0 minutes for propofol monotherapy and 35.75 minutes for combination sedation (P = .918). The average PACU cost was $566.37 for propofol monotherapy and $578.44 for combination sedation (P = .918). The average cost for sedatives was $3.13 for propofol monotherapy and $3.34 for combination sedation (P = .964). There was 1 incident of nausea among all patients. There were no significant differences in PACU length of stay, PACU cost, medication costs, and episodes of PONV between propofol monotherapy and combination sedation for outpatient GI endoscopy.