Fatigue and distress have been separately shown to be associated with medical errors.
The contribution of each factor when assessed simultaneously is unknown.
To determine the association of fatigue and distress with self-perceived major medical
errors among resident physicians using validated metrics.
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.
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.
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.
Among internal medicine residents, higher levels of fatigue and distress are independently
associated with self-perceived medical errors.