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Fatigue and stress in doctors in training linked to medical errors

Doctors in training who report higher levels of fatigue and distress are more likely to report a medical error, according to a new report.

In the study, doctors assessed the independent contributions of fatigue and distress to self-reported medical errors when considered simultaneously.

The study included data provided by 380 internal medicine residents who began training from 2003 to 2008 and completed surveys quarterly through February 2009. The surveys included self-assessment of medical errors, overall quality of life (QOL) and fatigue; and measures of burnout, depression, and sleepiness.

The average response rate to individual surveys was 67.5 per cent. Of the 356 participants providing error data, 39 per cent reported making at least one major medical error during the study period. In analyses, there was an association of subsequent self-reported error with measures of sleepiness and fatigue score. Each one-point increase in fatigue or sleepiness score was associated with a 14 per cent and 10 per cent increase, respectively, in the odds of reporting a medical error.

Subsequent error was also associated with burnout, a positive depression screen and overall QOL.

“Fatigue and distress variables remained statistically significant when modelled together with little change in the point estimates of effect. Sleepiness and distress, when modelled together, showed little change in point estimates of effect, but sleepiness no longer had statistical significance associated with errors when adjusted for burnout or depress-ion,” the researchers reported.

“In summary, this study suggests that fatigue, sleep-iness, burnout, depression, and reduced QOL are independently associated with an increased risk of future self-perceived major medical errors. In addition to the national efforts to reduce fatigue and sleepiness, well-designed interventions to prevent, identify, and treat distress among physicians are needed.

Additional research is necessary to determine the most effective strategies for accomplishing these goals. Changes to the process of physician training should address both resident fatigue and distress in an effort to improve resident and patient safety,” the authors concluded.

JAMA 2009;302:1294-1300

Posted in Mental Health & CNS on 18 November 2009
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abortion, accupuncture, ACE inhibitors, acne, ADHD, alcohol, allergies, Alzheimer's, anaemia, anaethesia, anorexia, antibiotics, antidepressants, antihistamine, anxiety, appetite control, arthritis, ASCOT, aspirin, asthma, atherosclerosis, autism, autoantibodies, back pain, beta carotene, beta-blockers, bipolar disorder, birth, bleeding, blindness, blood pressure, body dysmorphic disorder, body mass, breast cancer, breast feeding, bronchitis, Caesarean section, calcium, cancer, carcinogens, carcinoma, cardiac syncope, cardiolgy, cataracts, cervical cancer, chemotherapy, child psychiatry, children, cholesterol, clinical trial, clopidogrel, Clostridium difficile, cognitive behavioural therapy, colectomy, colic, colorectal cancer, complementary and alternative therapies, contraception, COPD, coronary care, coronary stents, Crohn's, cystic fibrosis, defibrillator, dementia, depression, dermatology, diabetes management, diet, disability, DNA, Down's syndrome, eating disorders, echinacea, ECT, eczema, elderly people, endoscopy, epilepsy, erectile dysfunction, euthanasia, exercise, fat, fertility, fitness, flu pandemic, fluoxetine, folic acid, food labelling, fracture, fragile X syndrome, general surgery, genetics, gerontology, GIK infusion therapy, GORD, gout, haemodialysis, hearing, heart attack, heart disease, heart failure, heart health, hepatitis, HIV, hospital care, HPV, HRT, hyperglycaemia, hypertension, hypoglycaemia, IBD, ICU, incontinence, infant, infant mortality, infection, inflammatory bowel disease, influenza, invasive candidiasis, IQ, Irish Heart Foundation, irritable bowel syndrome, keyhole surgery, kidney disease, laser, learning difficulties, leukaemia, liver disease, lumbar disk herniation, lung cancer, lung disease, lymph nodes, macular degeneration, macular oedema, magnetic resonance imaging (MRI), malaria, malnutrition, Marfan syndrome, media, medical ethics, medical research, medication, meningitis, mental illness, metabolic syndrome, migraine, miscarriage, mortality rate, MRSA, multiple sclerosis (MS), NCHDs, nephrology, neurology, OAB, obesity, obstetrics, occupational health, ocular medicine, omega-3, opthalmology, oral cancer, organ transplantation, orthopaedics, osteoporosis, otolaryngology, ovarian cancer, paediatrics, pain management, pancreatic cancer, panic, Parkinson’s disease, patient safety, patient-physician communication, personality disorders, physiotherapy, plastic surgery, polio, practice, pre-eclampsia, pregnancy, preventative health care, probiotics, prostate cancer, psoriasis, psychiatric admission, psychiatry, psychotherapy, PTSD, public health, quality of life, radiology, radiotherapy, rectal cancer, reproductive health, research, resuscitation, rheumatoid arthritis, rheumatology, rhinitis, salt, SARS, schizophrenia, screening, seizures, self harm, sexual abuse, sexual health, sexually transmitted infections, SGA, sinusitis, skin cancer, sleep disorders, smoking, smoking ban, spinal injury, sports medicine, statins, stress, stroke, substance abuse, suicide, supplement, surgery, syncope, technology, teenagers, testosterone, thoracic surgery, thrombosis, thyroid cancer, tonsillectomy, tonsillitis, Tourette's syndrome, toxicology, travel medicine, tuberculosis, tumour angiogenesis, type 1 diabetes, type 2 diabetes, ulcer, ulcerative colitis, urinary incontinence, vaccine, vitamins, weight, WHO, women's health, World Health Assembly

«Previous article | Next article»

Fatigue and stress in doctors in training linked to medical errors

Doctors in training who report higher levels of fatigue and distress are more likely to report a medical error, according to a new report.

In the study, doctors assessed the independent contributions of fatigue and distress to self-reported medical errors when considered simultaneously.

The study included data provided by 380 internal medicine residents who began training from 2003 to 2008 and completed surveys quarterly through February 2009. The surveys included self-assessment of medical errors, overall quality of life (QOL) and fatigue; and measures of burnout, depression, and sleepiness.

The average response rate to individual surveys was 67.5 per cent. Of the 356 participants providing error data, 39 per cent reported making at least one major medical error during the study period. In analyses, there was an association of subsequent self-reported error with measures of sleepiness and fatigue score. Each one-point increase in fatigue or sleepiness score was associated with a 14 per cent and 10 per cent increase, respectively, in the odds of reporting a medical error.

Subsequent error was also associated with burnout, a positive depression screen and overall QOL.

“Fatigue and distress variables remained statistically significant when modelled together with little change in the point estimates of effect. Sleepiness and distress, when modelled together, showed little change in point estimates of effect, but sleepiness no longer had statistical significance associated with errors when adjusted for burnout or depress-ion,” the researchers reported.

“In summary, this study suggests that fatigue, sleep-iness, burnout, depression, and reduced QOL are independently associated with an increased risk of future self-perceived major medical errors. In addition to the national efforts to reduce fatigue and sleepiness, well-designed interventions to prevent, identify, and treat distress among physicians are needed.

Additional research is necessary to determine the most effective strategies for accomplishing these goals. Changes to the process of physician training should address both resident fatigue and distress in an effort to improve resident and patient safety,” the authors concluded.

JAMA 2009;302:1294-1300

Posted in Mental Health & CNS on 18 November 2009
Tags: