Bystander effect hurts patients

NEJM study: Larger groups fail to intervene in emergencies
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Forty people did nothing to intervene when a woman was murdered. That was in 1964 in the streets of New York City. Researchers have long studied "Genovese syndrome," the lack of bystander intervention when Catherine "Kitty" Genovese was attacked. Now, they've found that the same "bystander effect" is prevalent in healthcare organizations.

According to yesterday's New England Journal of Medicine, the phenomenon assumes no one does anything because they think others will take responsibility in an emergency.

Researchers from the Yale School of Medicine found in one case, more than 40 physicians were involved in the care of one intensive care unit patient. Because so many providers cared for the patient, he actually became sicker, ABC News reported. They found the larger the group, the more likely the bystander effect may occur.

The doctors couldn't easily name the patient's disease, indicating "ambiguity about 'ownership' of the patient," coauthor Jason Lott, postdoctoral fellow in dermatology and internal medicine at the Yale School of Medicine, said in a statement.

The research is particularly disturbing, given the number of staff in large hospitals.

Even though the physicians were excellent doctors with good intentions, study author Robert R. Stavert told ABC News, there are pitfalls that hospitals could easily slip into. In addition to "social loafing," other pressures, including resident work hour limits, physician fatigue and complex patient conditions, may be to blame.

Study authors, nevertheless, said individuals may be more likely to act when they are friends with one another and suggested cross-specialty collaboration.

"[S]ystems which encourage structured cooperation and collaboration across specialties within a hospital may reduce the likelihood of this tendency. Additionally, reimbursement models which reward collaboration may be beneficial in improving coordination of care and limiting the impact of this potential pitfall," Stavert said in the statement.

Such collaborative improvement systems include TeamSTEPPS, an evidence-based teamwork system from the Agency for Healthcare Research and Quality used to improve healthcare quality, safety and efficiency. Another is IPASS, a patient safety and medical education initiative developed by Boston Children's Hospital that standardizes patient handoffs during shift changes.

For more:
- see the research announcement
- here's the article abstract
- read the ABC News article

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