The exponential growth of telemedicine in ambulatory care triggered by the COVID-19 public health emergency has undoubtedly impacted the quality of care and patient safety. In particular, the increased adoption of remote care has impacted communication, care teams, and patient engagement, which are key factors that impact patient safety in ambulatory care. In this perspective, we draw on a scoping review of the literature, our own clinical experiences, and conversations with patient safety experts to describe how changes in communication, care teams, and patient engagement have impacted two high priority areas in ambulatory safety: diagnostic errors and medication safety. We then provide recommendations for research funders, researchers, healthcare systems, policy makers, and healthcare payors for how to improve patient safety in telemedicine based on what is currently known as well as next steps for how to advance understanding of the safety implications of telemedicine utilization.

OBJECTIVES: Involvement in adverse events can negatively impact physician well-being. Because burnout is increasingly recognized as a threat to patient safety, we examined the relationship between physician adverse event involvement and burnout as well as facilitators and barriers to support among physicians experiencing burnout. METHODS: We surveyed physicians in the United States who are members of the networking platform, Doximity. We conducted quantitative and qualitative analyses investigating experiences with adverse events, the impact of adverse events, the type of support the physician sought and received after the event, and burnout. RESULTS: Across specialties, involvement in an adverse event and burnout was common. Most respondents involved in an adverse event experienced emotional impact, but only a minority received support. Those reporting that the error resulted in emotional impact were more likely to experience burnout (adjusted odds ratio, 1.90; 95% confidence interval, 1.18-3.07); this association was mitigated by the most common form of support sought, peer support (adjusted odds ratio for burnout among those who received peer support versus those who did not, 0.65; 95% confidence interval, 0.52-0.82). Barriers to support after an adverse event include punitive culture and systems factors such as administrative bureaucracy. Facilitators that emerged include peer, professional, and spiritual support, mentorship, helping others, the learning environment, and improved/flexible working hours. CONCLUSIONS: Physicians who experienced emotional repercussions from adverse events were more likely to report burnout compared with those who did not. Respondents proposed barriers and facilitators to support that have not been widely implemented. Peer support may help mitigate physician burnout related to adverse events.

BACKGROUND:The second victim effect is defined as emotional distress experienced by providers involved in mistakes. This study characterises events contributing to the second victim effect among a diverse sample of physician mothers, describes the impact on both provider and patient and seeks to determine the association between experiencing a mistake and burnout. METHODS:In this mixed-methods study, an anonymous, cross-sectional survey was posted to an online network of over 65 000 physician mothers on 17 June 2016. Self-reported involvement in a mistake provided opportunity to describe the error and impact on both provider and patient. Free-text responses were qualitatively coded to identify error types. Hypothesising that making a mistake contributes to burnout, self-reported burnout was examined using a single question. We used logistic regression to estimate the association between involvement in a mistake and burnout, adjusting for practice years, setting and specialty. RESULTS:5782 members completed the survey for an estimated response rate of 16.5% based on 34956 active users during the survey period. 2859 respondents reported involvement in a mistake (49%), which was associated with higher reported burnout (p<0.0001). 56% of those reporting a mistake provided descriptions. Qualitative analysis revealed that self-reported treatment errors were more common and diagnostic errors were most often reported to result in greater patient harm. Of those involved in a mistake, 82% reported feelings of guilt; 2.2% reported reducing clinical workload, taking leave or leaving the profession. CONCLUSIONS:Physician mothers involved in errors experience negative outcomes and may be at increased risk for burnout. Additional research should focus on strategies to mitigate burnout associated with the second victim effect, particularly among women physicians and those with family responsibilities.

BACKGROUND: The second victim effect is defined as emotional distress experienced by providers involved in mistakes. This study characterises events contributing to the second victim effect among a diverse sample of physician mothers, describes the impact on both provider and patient and seeks to determine the association between experiencing a mistake and burnout. METHODS: In this mixed-methods study, an anonymous, cross-sectional survey was posted to an online network of over 65 000 physician mothers on 17 June 2016. Self-reported involvement in a mistake provided opportunity to describe the error and impact on both provider and patient. Free-text responses were qualitatively coded to identify error types. Hypothesising that making a mistake contributes to burnout, self-reported burnout was examined using a single question. We used logistic regression to estimate the association between involvement in a mistake and burnout, adjusting for practice years, setting and specialty. RESULTS: 5782 members completed the survey for an estimated response rate of 16.5% based on 34956 active users during the survey period. 2859 respondents reported involvement in a mistake (49%), which was associated with higher reported burnout (p<0.0001). 56% of those reporting a mistake provided descriptions. Qualitative analysis revealed that self-reported treatment errors were more common and diagnostic errors were most often reported to result in greater patient harm. Of those involved in a mistake, 82% reported feelings of guilt; 2.2% reported reducing clinical workload, taking leave or leaving the profession. CONCLUSIONS: Physician mothers involved in errors experience negative outcomes and may be at increased risk for burnout. Additional research should focus on strategies to mitigate burnout associated with the second victim effect, particularly among women physicians and those with family responsibilities.