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Title: The Human Factor: The Impact of Work Hours, Sleep Deprivation, and Burnout on Patient Safety Tuesday, March 20, 2007 8:00


1
The Human Factor The Impact of Work Hours, Sleep
Deprivation, and Burnout on Patient
SafetyTuesday, March 20, 2007800 900 p.m.
EDT
2
  • Moderator
  • Christopher Landrigan, MD, MPH, FAAP
  • Pediatric Hospitalist, Research and Fellowship
    Director
  • Childrens Hospital Boston, Inpatient Pediatrics
    Service
  • Boston, Massachusetts

3
This activity was funded through an educational
grant from the Physicians Foundation for Health
Systems Excellence.
4
Disclosure of Financial Relationships and
Resolution of Conflicts of Interest for AAP CME
Activities Grid
  • The AAP CME program aims to develop, maintain,
    and increase the competency, skills, and
    professional performance of pediatric healthcare
    professionals by providing high quality,
    relevant, accessible and cost-effective
    educational experiences. The AAP CME program
    provides activities to meet the participants
    identified education needs and to support their
    lifelong learning towards a goal of improving
    care for children and families (AAP CME Program
    Mission Statement, August 2004).
  • The AAP recognizes that there are a variety of
    financial relationships between individuals and
    commercial interests that require review to
    identify possible conflicts of interest in a CME
    activity. The AAP Policy on Disclosure of
    Financial Relationships and Resolution of
    Conflicts of Interest for AAP CME Activities is
    designed to ensure quality, objective, balanced,
    and scientifically rigorous AAP CME activities by
    identifying and resolving all potential conflicts
    of interest prior to the confirmation of service
    of those in a position to influence and/or
    control CME content. The AAP has taken steps to
    resolve any potential conflicts of interest.
  • All AAP CME activities will strictly adhere to
    the 2004 Updated Accreditation Council for
    Continuing Medical Education (ACCME) Standards
    for Commercial Support Standards to Ensure the
    Independence of CME Activities. In accordance
    with these Standards, the following decisions
    will be made free of the control of a commercial
    interest identification of CME needs,
    determination of educational objectives,
    selection and presentation of content, selection
    of all persons and organizations that will be in
    a position to control the content, selection of
    educational methods, and evaluation of the CME
    activity.
  • The purpose of this policy is to ensure all
    potential conflicts of interest are identified
    and mechanisms to resolve them prior to the CME
    activity are implemented in ways that are
    consistent with the public good. The AAP is
    committed to providing learners with commercially
    unbiased CME activities.

5
DISCLOSURES
6
DISCLOSURES
7
DISCLOSURES
8
CME CREDIT
  • The American Academy of Pediatrics (AAP) is
    accredited by the Accreditation Council for
    Continuing Medical Education to provide
    continuing medical education for physicians.
  •  
  • The AAP designates this educational activity for
    a maximum of 1.0 AMA PRA Category 1 Credit.
    Physicians should only claim credit commensurate
    with the extent of their participation in the
    activity.
  •  
  • This activity is acceptable for up to 1.0 AAP
    credit. This credit can be applied toward the
    AAP CME/CPD Award available to Fellows and
    Candidate Fellows of the American Academy of
    Pediatrics.

9
OTHER CREDIT
  • This webinar is approved by the National
    Association of Pediatric Nurse Practitioners
    (NAPNAP) for 1.2 NAPNAP contact hours of which
    0.0 contain pharmacology (Rx) content. The AAP
    is designated as Agency 17. Upon completion of
    the program, each participant desiring NAPNAP
    contact hours should send a completed certificate
    of attendance, along with the required recording
    fee (10 for NAPNAP members, 15 for nonmembers),
    to the NAPNAP National Office at 20 Brace Road,
    Suite 200, Cherry Hill, NJ 08034-2633.
  •  
  • The American Academy of Physician Assistants
    accepts AMA PRA Category 1 Credit(s)TM from
    organizations accredited by the ACCME .

10
The Human Factor The Impact of Work Hours, Sleep
Deprivation, and Burnout on Patient Safety
American Academy of Pediatrics WebinarMarch
20, 2007
  • Christopher P. Landrigan, MD, MPH
  • Director, Sleep and Patient Safety Program,
    Brigham and Womens Hospital
  • Research Director, Childrens Hospital Boston
    Inpatient Pediatrics Service
  • Assistant Professor of Pediatrics and Medicine,
    Harvard Medical School

11
To Err is Human(Institute of Medicine, 1999)
  • 44,000 to 98,000 deaths per year due to adverse
    events
  • Focus on systemic issues
  • Report notably silent on issue of provider
    working conditions and mental health
  • lack of empiric data at that time
  • Considerable accumulation of information in past
    3-4 years

12
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13
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14
  • Harvard Work Hours, Health, and Safety Study
  • National Study of Work Hours and Injuries in
    2,737 Interns

Motor Vehicle Crashes
Percutaneous Injuries
OR 2.3 (95 CI, 1.6-3.3)
OR 1.6 (95CI, 1.5-1.8)
Extended shifts Non-extended shifts
Ayas, et al. JAMA 2006 2961055-1062
Barger LK et al. NEJM 2005 352125-134
15
Intern Sleep and Patient Safety Study
  • Randomized Trial comparing interns alertness and
    performance on traditional q3 schedule with
    24-30 hour shifts (ACGME-compliant ) vs. 16 hr
    max schedule
  • Twice as many EEG-documented attentional failures
    at night on traditional schedule

No. of attentional failures from 11pm 7am per
Hour on Duty
p0.02
Lockley, S. W. et al. N Engl J Med
20043511829-1837
16
  • Intern Sleep and Pt Safety Study, Part 2
  • Interns made 36 more serious errors on
    traditional schedule, including 5 times as many
    serious diagnostic errors

plt0.001
Errors per 1000 pt days
p0.03
plt0.001
Landrigan, C.P. et al. N Engl J Med
20043511838-1848
Landrigan, C. P. et al. N Engl J Med
20043511838-1848
17
ACGME Duty Hour Standards
  • lt80 hours per week, averaged over four weeks
  • lt30 hours in a row, including time for hand-offs
    of care and education
  • 1 day off in 7, averaged over four weeks
  • Implemented in July 2003
  • Goal to reduce extreme work hours, and
    consequently improve patient safety

18
ACGME Duty Hours Compliance Study
  • 83.6 of interns in violation of standards
    during
  • at least one month of the year
  • 61.5 of all inpatient intern-months in violation

Work and Sleep, Pre- vs. Post-Implementation
plt0.001
plt0.001
Landrigan C.P., et al. JAMA 20062961063-1070
19
Patient Safety, Resident Sleep, Depression, and
Burnout
  • Mark Joffe sleep deprivation and human
    performance
  • Amy Fahrenkopf burnout, depression, and resident
    performance

20
  • Mark Joffe, MD, FAAP
  • Director, Community Pediatric Medicine
  • The Childrens Hospital of Philadelphia
  • The University of Pennsylvania School of Medicine
  • Philadelphia, Pennsylvania

21
The Human Factor The Impact of Work Hours,
Sleep Deprivation, and Burnout on Patient Safety
  • Mark Joffe, M.D.
  • The Childrens Hospital of Philadelphia

22
Physician, heal thyself!
23
Consequences of Sleep Deprivation
  • Decreased longevity in animal models
  • Chronic hypertension
  • Increased cardiovascular mortality
  • ( gt 1 PPD cigarettes)
  • Infertility
  • Injuries

24
Social Cost of Sleep Deprivation
  • Depression
  • Divorce
  • Alcohol / Drug Addiction

25
Chernobyl 123 AM Bhopal 1240 AM Three
Mile Island 400 AM
26
Error Rate vs Time of Day
27
Car Crashes vs Time of Day
28
Federal Regulationsfor Truckers
  • 10 hour maximum without break
  • 15 hour max without 8 hour break
  • 60 driving hours/7day period

29
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30
Fatigue-Related Impairments
  • Passive vigilance
  • Reaction time
  • Hand-eye coordination
  • Clerical accuracy
  • Memory
  • Reasoning

31
Provider Fatigue vs Performancemeta-analysis,
resident physicians
  • Sleep debt lt 30 hrs
  • Overall performance reduced 1 std deviation
  • Clinical Performance reduced 1.5 std deviation

  • Philibert

32
Provider Fatigue vs PerformanceOutcomes
attention and simulated driving
  • Heavy call vs light call (residents)
  • Reaction time 7 slower
  • Commission errors 40 greater
  • Lane variability 27 greater
  • Speed variability 71 greater
  • Post-call performance equal to 0.05 g blood
    alcohol
  • Arnedt

33
Provider Fatigue vs Alcohol effects on
performance
  • 18-24 hours of continuous wakefulness causes
    performance decline equal to blood alcohol level
    of 0.1
  • (William,
    Dawson)
  • Fatigue-related impairment expressed as
    blood-alcohol equivalent

34
Provider Fatigue and Medical Errors
  • Medication errors 2.5 times more likely between
    4-8 AM (Kozer)
  • Fatigued surgeons make 20 more errors in
    simulated laporoscopic surgery

  • (Taffinder)

35
Physiology of Sleep
36
Circadian cycling promotes the acquisition of
regular and adequate sleep
  • Overcoming this intrinsic biological
    predisposition is very, very difficult

37
Circadian Timekeeping
  • A property of all higher life forms
  • Humans evolved to work during the daylight hours
  • After-hours work is a recent societal need that
    is out of harmony with our evolutionary
    inheritance

38
Circadian Rhythms
  • Organisms have their own endogenous biological
    clock
  • Circadian rhythms are affected by endogenous and
    exogenous factors
  • Exogenous time setters Zeitgebers light more
    potent than cultural/social cues

39
Suprachiasmatic Nucleus
  • Locus of biologic rhythmicity
  • Neurons have circadian rhythmicity that is
    intracellular in origin
  • Genes coding for the clock function have been
    identified

40
Body Temperature Cycle
O F
99
99
sleep
Sleep
98
97
97
8 12 16 20 0
4 8
8
12
16
20
MN
4
8
Hour
41
Measures of alertness track closely with body
temperature, with nadirs is the very early morning
42
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43
Mean Leg Strength after westward flight across 5
time zones
44
Sleep Architecture
  • Stage 1 if awakened people say they werent
    asleep. Automatic behavior may be Stage 1 sleep
  • Stage 2 half of sleep time in stage 2 Comes
    between periods of deep


    sleep and REM

45
Stages 3 - 4 (Slow wave or delta sleep - SWS)
  • Most vital, for recuperation, immune function
  • First to be made up after sleep deprivation
  • SWS increases after intellectually challenging
    tasks
  • Most SWS occurs during the first half of the
    sleep period

46
REM (brain on, body off)
  • Rapid eye movements
  • Wakeful EEG pattern
  • Increased cerebral blood flow
  • Absent spinal reflexes

47
Sleep Architecture
W
1
REM
2
34
(SWS)
1 2 3
4 5 6 7 8
75 SWS
75 REM
48
Slow Wave Sleep deprivation is associated with
reduction in cognitive performance
49
REM Deprivation
  • Moodiness
  • Hypersensitivity
  • Inability to consolidate complex learning
  • REM appears to be important for psychological
    well-being

50
Sleep Debt
  • Sleep latency can be measured
  • Very poor correlation between self-reported
    sleepiness and objective measures of fatigue

51
Variability in Sleep Requirements
  • gt 7 1/2 hours is optimal for most adults
  • Tolerance of sleep deprivation varies
  • Night owls vs early birds

52
Light and Melatonin
  • Bright light very early in the morning can cause
    a phase advance
  • Melatonin secreted by pineal gland signals brain
    that it is time to sleep
  • Light suppresses melatonin secretion

53
Bright lighting can reduce fatigue for workers
forced to work at night
54
Sedative-Hypnotics
  • Alcohol causes sleep fragmentation and decreased
    REM
  • Most sedative-hypnotics disrupt the architecture
    of sleep

55
Age Effects
  • REM and melatonin secretion decreases
  • Quality not maintained over 12 hour shifts
  • Do not tolerate irregular shifts, disrupted sleep
    as well as younger workers
  • Age correlates with increased morningness
  • At what age should overnight coverage end?

56
Circadian Adjustment
  • Circadian shift of 1-2 hours per day is maximum
  • Days off on regular schedule shifts cycle back
    towards normal
  • It takes at least a week and usually longer to
    adjust to a new shift

57
Short-term Countermeasures
58
Strategic Napping
  • Schedule your sleep as you schedule your work
  • Avoid caffeine and alcohol before nap time
  • Darken the room
  • Make sure room is quiet or have white noise
    (micro-awakenings decreases time in SWS and REM)

59
Napping
  • 23,681 Greek adults
  • Controlled for diet, other confounders
  • Mean 6.3 yr follow-up
  • Regular siesta was associated with 37
    reduction in coronary mortality

  • (Naska)

60
Interventions - caffeine Worlds most
popular drug
  • Mild CNS stimulant
  • 3.5 - 6 hr half-life
  • 250 mg improves psychomotor function if sleep
    deprived, 500 mg side effects w/o improvement
  • Tachyphylaxis
  • Withdrawal headaches
  • Affects sleep latency and sleep quality

61
Do you know what dose youre taking?
  • No-Doz max strength
  • Brewed Coffee (average)
  • Excedrin (2)
  • Instant Coffee
  • Mountain Dew
  • Orange Pekoe Tea
  • Coke Classic
  • Hersheys Dark Chocolate
  • Green Tea
  • Hersheys Milk Chocolate
  • Decaffeinated Coffee
  • 200 mg
  • 135 mg
  • 130 mg
  • 100 mg
  • 55 mg
  • 50 mg
  • 35 mg
  • 30 mg
  • 30 mg
  • 10 mg
  • 5 mg

62
Modafinil Provigil
  • Narcolepsy
  • Obstructive Sleep Apnea
  • Military short-term fatigue countermeasure
  • Shift Work Sleep Disorder

63
The only way to completely reverse the
physiologic need for sleep is to sleep
64
Summary
  • The evidence that fatigue impairs human
    performance is incontrovertible
  • Physicians are human
  • Fatigue is a root cause of many medical errors

65
Summary
  • Optimizing performance requires that sleep
    management be high-priority!
  • Schedule clinical work with sleep in mind
  • Just say no to meetings and other commitments
    that disrupt optimal sleep management (and expect
    it from colleagues)
  • Family life must accommodate to sleep needs for
    physicians with after-hours responsibilities

66
References
  1. Naska A, Oikonomou E, Trichopoulou A. Siesta in
    healthy adults and coronary mortality in the
    general population. Arch Intern Med 167296,
    2007.
  2. William AM, Feyer A. Moderate sleep deprivation
    produces impairments in cognitive and motor
    performance equivalent to legally prescribed
    levels of alcohol intoxication. Occ Environ Med
    57(10)649-655, 2000.
  3. Philibert I. Sleep loss and performance in
    residents and nonphysicians a meta-analytic
    examination. Sleep 28(11)1392, 2005.
  4. Arnedt JT, Owens J, et al. Neurobehavioral
    performance of residents after heavy night call
    vs after alcohol ingestion. JAMA 294(9)1025,
    2005.
  5. Dawson D, Reid K. Fatigue, alcohol and
    performance impairment. Nature 388(6639)235,
    1997.
  6. Taffinder NJ, McManus IC, Gul Y, et al. Effect
    of sleep deprivation on surgeons dexterity on
    laparoscopy simulator. Lancet 1191352, 1998.
  7. Leape LL, Brennan TA, Laird N, et al. The nature
    of adverse events in hospitalized patients. NEJM
    324(6)377-384, 1991.
  8. Institute of Medicine, To Err is Human, National
    Academy Press 2000, Washington, D.C., p 49.
  9. Kaushal R, Bates DW, Landrigan C, et al.
    Medication errors and adverse drug events in
    pediatric inpatients. JAMA 2852114-2120, 2001.
  10. Kozer E, Scolnik D, Macpherson A, et al.
    Variables associated with medication errors in
    pediatric emergency medicine. Pediatrics
    110(4)737-742, 2002.

67
References
  1. Dement WC. The Promise of Sleep, Delacorte Press,
    NY 1999, p262-263.
  2. Akerstedt T, Knutsson a, AlfredssonL, et al.
    Shift work and cardiovascular disease. Scand J
    Work Environ Health 10490, 1984.
  3. Earnest DJ, Liang F, Ratcliff M, et al. Immortal
    time Circadian clock properties of rat
    suprachiasmatic cell lines. Science
    283(5404)693, 1999.
  4. Van Dongen HP. Baynard MD. Maislin G. Dinges DF.
    Systematic interindividual differences in
    neurobehavioral impairment from sleep loss
    evidence of trait-like differential
    vulnerability. Sleep. 27(3)423-33, 2004.
  5. Van Dongen HP. Vitellaro KM. Dinges DF.
    Individual differences in adult human sleep and
    wakefulness Leitmotif for a research agenda.
    Sleep 28(4)479-96, 2005.
  6. Weitman ED, Moline ML, et al. Chronobiology of
    aging Temperature, sleep-wake rhythms and
    entrainment. Neurobiol Aging 3299-309, 1982.
  7. Reid K, Dawson D. Comparing performance on a
    simulated 12 hour shift rotation in young and
    older subjects. Occ Environ Med 58(1)58-62,
    2001.
  8. Landrigan CP, Rothschild JM, et al. Effect of
    reducing interns work hours on serious medical
    errors in intensive care units. NEJM
    351(18)1838, 2004.
  9. van Duinen H, Lorist MM, Zijdewind I. The effect
    of caffeine on cognitive task performance and
    motor fatigue. Psychopharmacology. 180(3)539-47,
    2005.
  10. Czeisler CA, Walsh JK, Roth T, et al. Modafinil
    for excessive sleepiness associated with
    shift-work sleep disorder. NEJM 353(5)476, 2005.

68
  • Amy Fahrenkopf, MD, MPH
  • Pediatric Hospitalist
  • Childrens Hospital Boston
  • Boston, Massachusetts

69
Effects of Housestaff Burnout and Depression on
Patient Safety
  • American Academy of Pediatrics Webinar
  • March 20, 2007
  • Amy M. Fahrenkopf, M.D., M.P.H.
  • Department of Medicine
  • Childrens Hospital Boston

70
Introduction
  • Depression and burnout are highly prevalent among
    medical residents
  • Studies have documented burnout rates of 41-76,
    while depression rates have ranged from 7-56
  • Despite their frequency, little research has
    sought to quantify the effects of depression and
    burnout on patient care.

71
Burnout Definition
  • Burnout is a syndrome of emotional depletion and
    detachment that develops in response to chronic
    occupational stress
  • Burnout more likely to develop when job stress is
    high and personal autonomy is low
  • Differs from depression in that it primarily
    affects functioning within the work context, not
    other areas of an individuals life

72
Burnout Screening
  • Maslach Burnout Inventory
  • Gold standard for evaluating burnout
  • 22 question validated screening tool
  • Version available that is specific to health care
    industry
  • Identifies three domains of burnout
  • Emotional exhaustion
  • Depersonalization
  • Low personal achievement

73
Burnout in ResidencyWhat do we know?
  • Growing area of research, though studies tend to
    be small and single-centered
  • Burnout is a significant problem in all
    specialties
  • Medicine 41-76
  • OB/Gyn 50
  • Pediatrics 76
  • Anesthesia 47
  • Surgery 50-56

74
Burnout in ResidencyWhat do we know?
  • Burnout levels rise quickly within the first few
    months of residency
  • Burnout affects residents of all PGY levels
    equally, although depersonalization scores rise
    with each additional year of residency
  • Men may be affected more than women
  • ACGME work hour changes appear to have decreased
    burnout rates moderately, but study results have
    been contradictory

75
Depression Definition and Screening
  • Depressed mood and loss of interests for at least
    two consecutive weeks that interferes with daily
    life and normal functioning
  • In any given 1-year period, 9.5 of the general
    population will suffer from a depressive episode
  • Clinical diagnosis with many excellent, validated
    screening tools available

76
Depression in Residency What do we know?
  • Considerably less research done on resident
    depression than on burnout
  • Studies report prevalence rates from 7-56
  • Studies to date focus solely on intern year
  • Multiple studies have shown residents start
    intern year with low rates of depression (2-4)
    and jump to 30-56 within 3 to 6 months

77
Depression in Residency What do we know?
  • Most depressed residents are also burned out
    (80-95)
  • Most residents who screen positive for depression
    in these studies have no prior history of
    depression
  • Female residents more likely to be depressed

78
Depression and BurnoutIs there a link to
medical errors?
  • All published studies to date have focused on
    burnout and the link to self-reported medical
    errors or quality of care
  • No published study has attempted to link
    depression to medical errors
  • We will look at three studies that highlight the
    important issues

79
Burnout and Self-Reported Patient Care in an
Internal Medicine Residency ProgramShanafelt TD,
Bradley KA, Wipf JE, Back AL Ann Intern Med.
2002 136358-367
  • Survey of 115 internal medicine residents at
    University of Washington
  • Burnout measured by MBI
  • Self-reported patient care determined using tool
    developed for this study
  • Depression measured using two-question PRIME-MD
    screen

80
Burnout and Self-Reported Patient Care in an
Internal Medicine Residency ProgramShanafelt TD,
Bradley KA, Wipf JE, Back AL Ann Intern Med.
2002 136358-367
  • 76 burnout rate, of whom 50 also screened
    positive for depression
  • Burned out residents significantly more likely
    than non-burned out residents to report one or
    more suboptimal patient care monthly (53 vs 21
    p0.004)
  • In multivariate analyses burnout (but not sex or
    depression) associated with self-report of
    suboptimal patient care monthly (odds ratio 8.3
    95 CI, 2.6-26.5)

81
Association of Perceived Medical Errors with
Resident Distress and EmpathyWest CP, Huschka
MM, Novotny PJ, et. al. JAMA. 2006 2961071-1078
  • Prospective longitudinal cohort study of 184
    internal medicine residents at Mayo Clinic
  • Residents completed surveys of their quality of
    life and self-reported medical errors every three
    months for one year
  • Quality of life survey included MBI, 2-question
    depression screen, and a validated quality of
    life scale

82
Association of Perceived Medical Errors with
Resident Distress and EmpathyWest CP, Huschka
MM, Novotny PJ, et. al. JAMA. 2006 2961071-1078
  • 34 of residents reported making at least one
    major medical error
  • Self-perceived errors were associated with
    increased burnout in all domains (DP 3.23,
    plt0.001 EE6.85, plt0.001 PA 2.99, p0.001)

83
Association of Perceived Medical Errors with
Resident Distress and EmpathyWest CP, Huschka
MM, Novotny PJ, et. al. JAMA. 2006 2961071-1078
  • Self-perceived errors associated with odds ratio
    of 3.29 (95CI, 1.90-5.64) of screening positive
    for depression at next survey point
  • Increased burnout scores, in turn, associated
    with increased odds of self-reported errors in
    following 3 months

84
Rates of Medication Errors Among Depressed and
Burned Out House OfficersFahrenkopf AM, Sectish
TC, Barger LK, et.al (Presented at )
  • Prospective cohort study of 123 pediatrics
    residents at 3 large Childrens Hospitals
  • Childrens Hospital Boston
  • Lucile Packard Childrens Hospital
  • Childrens National Medical Center
  • Involved 3 components
  • Baseline resident questionnaire with MBI and 10
    question HANDS depression screen
  • 6 week resident sleep and work hour logs
  • Medication error collection at two sites

85
Housestaff Burnout and Depression The Link to
Patient SafetyFahrenkopf AM, Sectish TC, Barger
LK, et.al. Platform presentation, Agency for
Healthcare Research and Quality Patient Safety
Conference, Washington D.C., 2006
  • 19.5 of residents depressed and 74 burned out
  • 96 of depressed residents also burned out
  • 74 of those depressed had no prior history of
    depression
  • No correlation between depression or burnout with
    PGY year, gender, marital status, or
    self-reported sleep or work hours

86
Housestaff Burnout and Depression The Link to
Patient SafetyFahrenkopf AM, Sectish TC, Barger
LK, et.al. Platform presentation, Agency for
Healthcare Research and Quality Patient Safety
Conference, Washington D.C., 2006
  • 10,277 orders reviewed with 125 errors identified
  • 45 errors made by study subjects
  • 0 preventable adverse drug events, 28 potential
    adverse events, and 17 errors with little
    potential for harm.
  • 1 non-preventable ADE

87
Housestaff Burnout and Depression The Link to
Patient SafetyFahrenkopf AM, Sectish TC, Barger
LK, et.al. Platform presentation, Agency for
Healthcare Research and Quality Patient Safety
Conference, Washington D.C., 2006
Depression, Burnout, and Medication Errors per
Resident-Month

Errors per resident-month
depressed
burned out
88
Housestaff Burnout and Depression The Link to
Patient SafetyFahrenkopf AM, Sectish TC, Barger
LK, et.al. Platform presentation, Agency for
Healthcare Research and Quality Patient Safety
Conference, Washington D.C., 2006
Depression, Burnout, and Self-reported Medical
Errors


plt0.05 plt0.01 plt0.001
89
Areas for Further Research
  • Investigate the causal relationship between
    depression and errors
  • Better define how depression and burnout affect
    residents and patient care in other specialties
    AND among fellows and practicing physicians
  • Rigorously conducted intervention trials are
    needed to evaluate how to improve the mental
    health of trainees while decreasing medical
    errors and preserving educational quality.

90
Conclusion
  • Depression and burnout are significant problems
    among pediatric residents in all years of
    training
  • Both depressed and burned out residents
    self-report high rates of errors and poor health
  • Preliminary studies suggest that depressed
    residents have a nearly eight-fold increase in
    errors compared to their non-depressed colleagues

91
Conclusion
  • ACGME work hour regulations may have decreased
    burnout, but no change in depression
  • Further studies are needed to better establish
    the relationship between depression, burnout, and
    medical errors

92
Acknowledgements
  • Pediatric Work Hours Study Group
  • Harvard Work Hours, Health and Safety Group
  • Christopher Landrigan, MD, MPH

93
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