A peer-support program launched six years ago at Johns Hopkins Medicine to help doctors and nurses recover after traumatic patient-care events, such as a patient’s death, probably saves the institution close to $2 million annually, according to a recent cost-benefit analysis.
The findings, published online in the Journal of Patient Safety, might prompt other medical centers to offer similar programs—the benefits of which go far beyond the financial, the Johns Hopkins Bloomberg School of Public Health researchers say.
Clinicians who aren’t able to cope with the stress or don’t feel supported after these events often suffer a decrease in productivity, take time off, or quit their jobs, according to the authors.
“We often refer to medical providers who are part of these stressful events as ‘second victims,’” said study leader William V. Padula, PhD. “Although providers often aren’t considered to be personally affected, the impact of these events can last through their entire career.”
In 2011, Johns Hopkins Medicine started the RISE (Resilience In Stressful Events) program, which relies on a multidisciplinary network of peer counselors—nurses, physicians, social workers, chaplains, and other professionals. These counselors arrive or call a fellow clinician in need within 30 minutes after they request help following an emotionally difficult care-related event, such as a patient in extreme pain, dealing with an overwhelmed family, or a patient being harmed through a medical error.
Such events happen on a daily basis at academic medical centers, such as Johns Hopkins, with complicated and often very sick patient populations, Padula said.
Although he and others involved in the RISE program believe in its importance, regardless of cost, the program does require Johns Hopkins to redirect some resources, Padula pointed out. For example, although all peer counselors volunteer their time, that’s time taken away from other billable work, such as patient care. For Johns Hopkins to continue to invest in the program, Padula said, showing a financial benefit is key.
To explore whether such a benefit exists, Padula and his colleagues developed a model focused on the Johns Hopkins nursing population to investigate the likely financial outcomes of a year with or without the RISE program in place. The model used data from a survey delivered to nurses familiar with the RISE program, which inquired about their probability of quitting or taking a day off after a stressful event with or without the program in place. It also used Johns Hopkins human resources data as well as the average cost of replacing a lost nursing employee available in published literature, among other data.
After inputting this information into the model, the researchers found that the annual cost of the RISE program per nurse was approximately $656. However, they also found that the expected annual cost of not having the program in place was $23,232. Thus, the RISE program resulted in a net cost savings of $22,576 per nurse. Expanding that to encompass all users of the system—including doctors, who have a much higher cost per billable hour and dramatically higher replacement costs—the total savings to the institution in one year was expected to be approximately $1.81 million.
The savings alone are an attractive reason to implement a program such as RISE at other large, academic medical centers, Padula said. He added, however, that helping clinicians get through a stressful event is the right thing to do, regardless of the cost.
“It’s hard to put a true price on the emotional support and coping mechanisms this program provides for clinicians after tragic events,” he said.
Source: Johns Hopkins Bloomberg School of Public Health; May 10, 2017.