Association of intern and resident burnout with self-reported medical errors

Eui-Kyu Kang, Ho-Seob Lihm, Eun-Hee Kong, Eui-Kyu Kang, Ho-Seob Lihm, Eun-Hee Kong

Abstract

Background: Burnout is a common problem for interns and residents. It may be related to medical error, but little is known about this relationship. The purpose of this study was to determine the association between burnout and perceived medical errors among interns and residents.

Methods: The study group consisted of interns and residents working in a university hospital in Busan. Data were provided by 86 (58.5%) of 147 interns and residents. They completed a questionnaire including self-assessment of medical errors, a linear analog self-assessment of overall quality of life (QOL), fatigue, the Epworth Sleepiness Scale (ESS) score, the Maslach Burnout Inventory, and a validated depression screening tool.

Results: According to univariate logistic regression analyses, there was an association between perceived medical errors and fatigue (odds ratio [OR], 1.37 per unit increase; 95% confidence interval [CI], 1.12 to 1.69; P < 0.003) and ESS scores (OR, 1.13 per unit increase; 95% CI, 1.03 to 1.23; P < 0.009). Perceived medical errors were also associated with burnout (ORs per 1-unit change; emotional exhaustion OR, 1.07; 95% CI, 1.02 to 1.13; P < 0.005; depersonalization OR, 1.11; 95% CI, 1.02 to 1.21; P < 0.013), a negative depression screen (OR, 0.29; 95% CI, 0.11 to 0.76; P < 0.013), and overall QOL (OR, 0.80; 95% CI, 0.70 to 0.98; P < 0.033). In multivariate logistic regression analyses, an association was identified between perceived medical errors and emotional exhaustion (OR, 1.06; 95% CI, 1.00 to 1.11; P < 0.046) when adjusted for ESS, and depersonalization (OR, 1.01; 95% CI, 1.01 to 1.19; P < 0.04) when adjusted for fatigue.

Conclusion: Higher levels of burnout among interns and residents were associated with perceived medical errors.

Keywords: Burnout; Medical Errors; Resident.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

References

    1. Kohn LT, Corrigan J, Donaldson MS Institute of Medicine (US); Committee on Quality of Health Care in America. To err is human: building a safer health system. Washington (DC): National Academy Press; 1999.
    1. Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, et al. Effect of reducing interns' work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351:1838–1848.
    1. Barger LK, Ayas NT, Cade BE, Cronin JW, Rosner B, Speizer FE, et al. Impact of extended-duration shifts on medical errors, adverse events, and attentional failures. PLoS Med. 2006;3:e487.
    1. Lockley SW, Barger LK, Ayas NT, Rothschild JM, Czeisler CA, Landrigan CP, et al. Effects of health care provider work hours and sleep deprivation on safety and performance. Jt Comm J Qual Patient Saf. 2007;33(11 Suppl):7–18.
    1. Fahrenkopf AM, Sectish TC, Barger LK, Sharek PJ, Lewin D, Chiang VW, et al. Rates of medication errors among depressed and burnt out residents: prospective cohort study. BMJ. 2008;336:488–491.
    1. Maslach C. Burned-out. Hum Behav. 1976;5:16–22.
    1. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14:540–545.
    1. Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep. 1992;15:376–381.
    1. Gudex C, Dolan P, Kind P, Williams A. Health state valuations from the general public using the visual analogue scale. Qual Life Res. 1996;5:521–531.
    1. Shanafelt TD, Novotny P, Johnson ME, Zhao X, Steensma DP, Lacy MQ, et al. The well-being and personal wellness promotion strategies of medical oncologists in the North Central Cancer Treatment Group. Oncology. 2005;68:23–32.
    1. Rummans TA, Clark MM, Sloan JA, Frost MH, Bostwick JM, Atherton PJ, et al. Impacting quality of life for patients with advanced cancer with a structured multidisciplinary intervention: a randomized controlled trial. J Clin Oncol. 2006;24:635–642.
    1. Maslach C, Jackson SE, Leiter MP. Maslach burnout inventory manual. 3rd ed. Palo Alto: Consulting Psychologists Press; 1996.
    1. Maslach C, Jackson SE. Maslach burnout inventory. Palo Alto: Consulting Psychologists Press; 1981.
    1. Choi HY. A study on affecting factors of social workers burnout [master's thesis] Seoul: Yonsei University; 1994.
    1. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136:358–367.
    1. Thomas NK. Resident burnout. JAMA. 2004;292:2880–2889.
    1. Gopal R, Glasheen JJ, Miyoshi TJ, Prochazka AV. Burnout and internal medicine resident work-hour restrictions. Arch Intern Med. 2005;165:2595–2600.
    1. Rosen IM, Gimotty PA, Shea JA, Bellini LM. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Acad Med. 2006;81:82–85.
    1. Spitzer RL, Williams JB, Kroenke K, Linzer M, deGruy FV, 3rd, Hahn SR, et al. Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study. JAMA. 1994;272:1749–1756.
    1. Whooley MA, Avins AL, Miranda J, Browner WS. Case-finding instruments for depression. Two questions are as good as many. J Gen Intern Med. 1997;12:439–445.
    1. West CP, Huschka MM, Novotny PJ, Sloan JA, Kolars JC, Habermann TM, et al. Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA. 2006;296:1071–1078.
    1. Williams JW, Jr, Noel PH, Cordes JA, Ramirez G, Pignone M. Is this patient clinically depressed? JAMA. 2002;287:1160–1170.
    1. Claus KE. The nature of stress. In: Claus KE, Bailey JT, editors. Living with stress and promoting well-being: a handbook for nurses. St. Louis: Mosby; 1980. pp. 9–15.
    1. Freudenberger HJ. Burn-out: the organizational menace. Train Dev J. 1977;31:26–27.
    1. Pines AM, Kanner AD. Nurses' burnout: lack of positive conditions and presence of negative conditions as two independent sources of stress. J Psychosoc Nurs Ment Health Serv. 1982;20:30–35.
    1. Melamed S, Shirom A, Toker S, Berliner S, Shapira I. Burnout and risk of cardiovascular disease: evidence, possible causal paths, and promising research directions. Psychol Bull. 2006;132:327–353.
    1. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA. 2009;302:1294–1300.

Source: PubMed

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