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Cited by 999Healthcare professionals’ stress and burnoutPatient Safety and Medication ErrorsHospital Admissions and Outcomes

Association of resident fatigue and distress with perceived medical errors

West, Colin P.·2009·JAMA
DOI 10.1001/jama.2009.1389
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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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Authors
West, C. P.
Affiliations
Mayo Clinic (US)
Corresponding author
West, Colin P.
ORCID
West, Colin P.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2009-09-23
Volume
302
Issue
12
Pages
1294
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2009.1389
OpenAlex
W2103160233
Cited by
999
References
39
Citations by year
2026: 38 · 2025: 56 · 2024: 65 · 2023: 52 · 2022: 79 · 2021: 109 · 2020: 102 · 2019: 88 · 2018: 56 · 2017: 63 · 2016: 54 · 2015: 38 · 2014: 50 · 2013: 43 · 2012: 38
FWCI
63.37
Type
journal article
Language
en
Open access
closed
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
Keywords
resident fatigue, burnout, depression, quality of life, sleepiness, internal medicine residents, physician well-being, emotional exhaustion, depersonalization, personal accomplishment, Epworth Sleepiness Scale, Maslach Burnout Inventory, patient safety
MeSH terms
Adult, Burnout, Professional, Depression, Fatigue, Female, Humans, Internal Medicine, Internship and Residency, Longitudinal Studies, Male, Minnesota, Prospective Studies, Quality of Life, Surveys and Questionnaires, Self Concept, Sleep Stages, Stress, Psychological, Students, Medical, Odds Ratio, Medical Errors

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