Safety coordinators

Adverse events (AEs) are the cause of injuries, harm, and/or suffering in patients but are also responsible for alterations in occupational, family, and/or personal aspects of professionals (second victims) who are involved in them and the loss of prestige and decrease in confidence in the health institutions (third victims) where these AE occur.

Between 28 and 57% of physicians (79-89% in the case of residents) acknowledge having committed a clinical error with severe consequences for one or more patients, while 90% considers that their hospital or health center did not offer appropriate help and support toward the professionals after the AE, which aggravated its consequences. As for Spain, through extrapolation of data on research on the frequency of adverse events, ENEAS in hospitals and APEAS in primary care, it is estimated that 15% of health professionals are seen to be involved in an AE with these characteristics every year.

The consequences for second victims, in affective and professional terms, as well as the interventions for coping with the stress that they cause, have been reviewed in several studies published between 2008 and 2013. The review by White et al. was oriented to offer clues for managers of health institutions about the problems of second victims. The personal consequences of AE in second victims are characterized by an anxiety response, affective symptoms, and morbid concern for their performance and professional capacity. We do know that these second victims change their manner of interaction with patients following an adverse event with severe consequences and that their practice becomes insecure. Strategies for coping with stress (Critical Incident Stress Management, CIMA, or BICEPS) have been taken as references for addressing the clinical situation of second victims. The consequences in third victims and how to address them, on the other hand, have hardly been studied, even though the elaboration of a crisis plan along with other measures for preventing the loss of prestige of the institution have been suggested. In this sense, health institutions and their managing teams could put diverse types of interventions for preventing and mitigating the effects of AE in second and third victims into practice. To date, all research has focused solely on hospitals, without any research published on this subject in primary care.


Supporting resources in the effective management of health risks

BACRA: A web tool for the analysis of safety incidents and the search for solutions

  • It is a web tool that strives to facilitate involvement by middle managers and first-line health professionals in the analysis of safety incidents as well as establishing a series of measures to implement to prevent their recurrence.
  • To accomplish this, it proposes an analysis method that is fast, easy, and safe.
  • It incorporates part of the protocols of incident analysis based on the Harvard study, analysis of the 5 Whys (a characteristic of root cause analysis), the prioritization of risks used in modal analysis of failures and effects, and the matrix employed in the improvement plan tool (PDCA).
  • It is not a resource that substitutes reporting systems–instead, it is complementary to them.
  • It does not require specific training to be used.
  • It offers full guarantees for legal safety of the professionals (the platform does not require entering personal data or any logins). The analysis remains encrypted by the password chosen by the professional/s carrying out the analysis.
  • It is focused on the search for solutions to prevent the same incident from reoccurring.
  • The final product is a matrix that includes identified causes, risk priority number (RPN), actions to implement, those responsible, dates, and follow-up measures (indicators).


For further information on BACRA: 

Carrillo I, Mira JJ, Vicente MA, Fernandez C, Guilabert M, Ferrús L, et al. Design and Testing of BACRA, a Web-Based Tool for Middle Managers at Health Care Facilities to Lead The Search for Solutions to Patient Safety Incidents . J Med Internet Res. 2016;18:e257.