Medical errors: Cause for stress in resident physicians

Internal medicine residents who reported higher levels of fatigue and distress were more likely to report a medical error, according to a study in the September 23/30 issue of JAMA, a theme issue on medical education.

"Medical errors and patient safety continue to be an important concern for patients and physicians, especially since the Institute of Medicine reported in 1999 that between 48,000 and 98,000 Americans die each year due to preventable adverse events," according to background information in the article. "Fatigue and distress have been separately shown to be associated with medical errors. The contribution of each factor when assessed simultaneously is unknown."

Colin P. West, M.D., Ph.D., of Mayo Clinic, Rochester, Minn., and colleagues 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 percent. Of the 356 participants (93.7 percent) providing error data, 39 percent reported making at least 1 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 1-point increase in fatigue or sleepiness score was associated with a 14 percent and 10 percent 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 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 statistical significance associated with errors when adjusted for burnout or depression," the researchers write.

"In summary, this study suggests that fatigue, sleepiness, 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 conclude.