How would you help a colleague dealing with the stress of an adverse outcome?

We will discuss ‘Post-traumatic stress symptoms in Swedish obstetricians and midwives after severe obstetric events: a cross-sectional retrospective survey by Wahlberg and coauthors on the 26th April 2017. This paper is free to view from 17th April.

Start date: 26 April 2017. The discussion will continue for 7 days until 2nd May 2017.

First hosted discussion session(s) on Twitter starts at BST 8pm (3pm EST/12 noon PST) on 26 April 2017 (using hashtag #BlueJC).

Host: @BlueJCHost

Follow us: Twitter

The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues.

The discussion points are below:

Scenario

A colleague working in another part country calls to tell you that she delivered a patient whose full term baby died in the NICU a few days after delivery. During the course of the hospital safety committee’s review of the case, it was determined that a delay in delivery likely contributed to complications leading to the neonate’s death.  Your colleague asks for advice and help “sorting it all out”.

How will you help?

Description of Research:

Participants 1,459 midwives and 706 obstetricians from Sweden. Mostly women.
Exposure A serious and potentially traumatic event on the delivery unit, such as (1) a child died or had severe asphyxia, (2) maternal near-miss or death during delivery, or (3) other difficult event such as violence or threat.
Outcomes Provider experience of probably post-traumatic stress disorder (PTSD) or partial PTSD.
Study design Cross-sectional survey.
Authors’ conclusion A substantial proportion of obstetricians and midwives experiences PTSD-like symptoms after serous traumatic events related to delivery.

Discussion Points:

  • Describe a time when you have been the “second victim” of an adverse event. How did it affect you? Did it have an effect on your other patients?
  • Did the authors have an adequate response rate to their survey? What means could they have used to improve response rates?
  • The authors cite probable selection bias and recall bias as limitations of the study. How would you design a study addressing the same objective, but with less potential for these biases?
  • In what ways might non-responders have biased this study?
  • What were the main differences between obstetrician responders and midwife responders in this study?
  • Obstetricians reported negative experiences with debriefings (or reassembly) in this study. In your experience, what are the ways debriefings can be helpful or harmful?
  • How would you use the results of this study in your own practice?

Suggested reading

  1. Scott et al. The natural history of recovery for healthcare provider “second victim” after adverse patient events. Qual Saf Health Care Care 2009;18:325-330.
  2. Schroder et al. Guilt without fault: a qualitative study into the ethics of forgiveness after traumatic childbirth. Social Science & Medicine 2017;176:14-20.
  3. Grimes and Schulz. Descriptive studies: what they can and cannot do. Lancet 2002;359:145-49.

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