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Association of resident fatigue and distress with perceived medical errors
Colin P West1, Angelina D Tan, Thomas M Habermann
1Division of General Internal Medicine, Department of Medicine, Mayo Clinic, 200 First St, SW, Rochester, MN 55905, USA. west.colin@mayo.edu
Context:
Fatigue and distress have been separately shown to be associated with medical errors. The contribution of each factor when assessed simultaneously is unknown.
Objective:
To determine the association of fatigue and distress with self-perceived major medical errors among resident physicians using validated metrics.
Design, Setting, And Participants:
Prospective longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic, Rochester, Minnesota. Data were provided by 380 of 430 eligible residents (88.3%). Participants began training from 2003 to 2008 and completed surveys quarterly through February 2009. Surveys included self-assessment of medical errors, linear analog self-assessment of overall quality of life (QOL) and fatigue, the Maslach Burnout Inventory, the PRIME-MD depression screening instrument, and the Epworth Sleepiness Scale.
Main Outcome Measures:
Frequency of self-perceived, self-defined major medical errors was recorded. Associations of fatigue, QOL, burnout, and symptoms of depression with a subsequently reported major medical error were determined using generalized estimating equations for repeated measures.
Results:
The mean response rate to individual surveys was 67.5%. Of the 356 participants providing error data (93.7%), 139 (39%) reported making at least 1 major medical error during the study period. In univariate analyses, there was an association of subsequent self-reported error with the Epworth Sleepiness Scale score (odds ratio [OR], 1.10 per unit increase; 95% confidence interval [CI], 1.03-1.16; P = .002) and fatigue score (OR, 1.14 per unit increase; 95% CI, 1.08-1.21; P < .001). Subsequent error was also associated with burnout (ORs per 1-unit change: depersonalization OR, 1.09; 95% CI, 1.05-1.12; P < .001; emotional exhaustion OR, 1.06; 95% CI, 1.04-1.08; P < .001; lower personal accomplishment OR, 0.94; 95% CI, 0.92-0.97; P < .001), a positive depression screen (OR, 2.56; 95% CI, 1.76-3.72; P < .001), and overall QOL (OR, 0.84 per unit increase; 95% CI, 0.79-0.91; P < .001). Fatigue and distress variables remained statistically significant when modeled together with little change in the point estimates of effect. Sleepiness and distress, when modeled together, showed little change in point estimates of effect, but sleepiness no longer had a statistically significant association with errors when adjusted for burnout or depression.
Conclusion:
Among internal medicine residents, higher levels of fatigue and distress are independently associated with self-perceived medical errors.
Insights
Higher fatigue and distress in internal medicine residents are independently linked to increased self-reported medical errors. These factors significantly impact patient safety and physician well-being.
Area of Science:
- Medical Education Research
- Patient Safety
- Physician Well-being
Background:
- Fatigue and distress are known risk factors for medical errors.
- The combined impact of fatigue and distress on medical errors remains unclear.
Purpose of the Study:
- To investigate the independent associations of fatigue and distress with self-perceived major medical errors.
- To utilize validated metrics for assessing these factors in resident physicians.
Main Methods:
- Prospective longitudinal cohort study involving internal medicine residents.
- Utilized validated surveys for fatigue, distress, burnout, sleepiness, quality of life, and self-reported medical errors.
- Generalized estimating equations were used to analyze repeated measures data.
Main Results:
- 39% of residents reported at least one major medical error.
- Increased fatigue, burnout, depression symptoms, and decreased quality of life were significantly associated with higher error rates.
- Fatigue and distress remained independently associated with errors when analyzed together.
Conclusions:
- Elevated levels of fatigue and distress are independent predictors of self-perceived medical errors among internal medicine residents.
- Addressing physician fatigue and distress is crucial for enhancing patient safety and medical quality.
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