Association of resident fatigue and distress with perceived medical errors

Colin Patrick West, Angelina D. Tan, Thomas Matthew Habermann, Jeff A Sloan, Tait D. Shanafelt

Research output: Contribution to journalArticle

401 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1294-1300
Number of pages7
JournalJAMA - Journal of the American Medical Association
Volume302
Issue number12
DOIs
StatePublished - Sep 23 2009

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Medical Errors
Fatigue
Odds Ratio
Confidence Intervals
Depression
Quality of Life
Internal Medicine
Depersonalization
Longitudinal Studies
Cohort Studies
Outcome Assessment (Health Care)
Physicians
Equipment and Supplies

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Association of resident fatigue and distress with perceived medical errors. / West, Colin Patrick; Tan, Angelina D.; Habermann, Thomas Matthew; Sloan, Jeff A; Shanafelt, Tait D.

In: JAMA - Journal of the American Medical Association, Vol. 302, No. 12, 23.09.2009, p. 1294-1300.

Research output: Contribution to journalArticle

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abstract = "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.",
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AU - West, Colin Patrick

AU - Tan, Angelina D.

AU - Habermann, Thomas Matthew

AU - Sloan, Jeff A

AU - Shanafelt, Tait D.

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N2 - 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.

AB - 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.

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