The Human Factor: The Impact of Work Hours, Sleep Deprivation, and Burnout on Patient Safety Tuesday, March 20, 2007 8:00 – 9:00 p.m. EDT: The Human Factor: The Impact of Work Hours, Sleep Deprivation, and Burnout on Patient Safety Tuesday, March 20, 2007 8:00 – 9:00 p.m. EDT
Slide2: Moderator:
Christopher Landrigan, MD, MPH, FAAP
Pediatric Hospitalist, Research and Fellowship Director
Children’s Hospital Boston, Inpatient Pediatrics Service
Boston, Massachusetts
This activity was funded through an educational grant from the Physicians’ Foundation for Health Systems Excellence.: This activity was funded through an educational grant from the Physicians’ Foundation for Health Systems Excellence.
Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities Grid: 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.
DISCLOSURES: DISCLOSURES
DISCLOSURES: DISCLOSURES
DISCLOSURES: DISCLOSURES
CME CREDIT: 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.
OTHER CREDIT: 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 .
The Human Factor: The Impact of Work Hours, Sleep Deprivation, and Burnout on Patient Safety American Academy of Pediatrics Webinar March 20, 2007: The Human Factor: The Impact of Work Hours, Sleep Deprivation, and Burnout on Patient Safety American Academy of Pediatrics Webinar March 20, 2007 Christopher P. Landrigan, MD, MPH
Director, Sleep and Patient Safety Program, Brigham and Women’s Hospital
Research Director, Children’s Hospital Boston Inpatient Pediatrics Service
Assistant Professor of Pediatrics and Medicine, Harvard Medical School
To Err is Human (Institute of Medicine, 1999) : 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
Slide14: Harvard Work Hours, Health, and Safety Study
National Study of Work Hours and Injuries in 2,737 Interns OR: 2.3 (95% CI, 1.6-3.3) Barger LK et al. NEJM 2005;
352:125-134 Motor Vehicle Crashes Percutaneous Injuries OR: 1.6 (95%CI, 1.5-1.8) Ayas, et al. JAMA 2006; 296:1055-1062
Extended shifts
Non-extended shifts
Slide15: No. of attentional failures from 11pm – 7am per Hour on Duty 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 Lockley, S. W. et al. N Engl J Med 2004;351:1829-1837 p=0.02
Slide16: 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 Landrigan, C. P. et al. N Engl J Med 2004;351:1838-1848 p<0.001 p<0.001 p=0.03 Landrigan, C.P. et al. N Engl J Med 2004;351:1838-1848 Errors per 1000 pt days
ACGME Duty Hour Standards: ACGME Duty Hour Standards <80 hours per week, averaged over four weeks
<30 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
ACGME Duty Hours Compliance Study : ACGME Duty Hours Compliance Study ‡ p<0.001 ‡ p<0.001 Landrigan C.P., et al. JAMA 2006;296:1063-1070 Work and Sleep, Pre- vs. Post-Implementation 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
Patient Safety, Resident Sleep, Depression, and Burnout: Patient Safety, Resident Sleep, Depression, and Burnout Mark Joffe: sleep deprivation and human performance
Amy Fahrenkopf: burnout, depression, and resident performance
Slide20: Mark Joffe, MD, FAAP
Director, Community Pediatric Medicine
The Children’s Hospital of Philadelphia
The University of Pennsylvania School of Medicine
Philadelphia, Pennsylvania
The Human Factor: The Impact of Work Hours, Sleep Deprivation, and Burnout on Patient Safety : The Human Factor: The Impact of Work Hours, Sleep Deprivation, and Burnout on Patient Safety Mark Joffe, M.D.
The Children’s Hospital of Philadelphia
“Physician, heal thyself!”: “Physician, heal thyself!”
Consequences of Sleep Deprivation: Consequences of Sleep Deprivation Decreased longevity in animal models
Chronic hypertension
Increased cardiovascular mortality
( > 1 PPD cigarettes)
Infertility
Injuries
Social Cost of Sleep Deprivation: Social Cost of Sleep Deprivation Depression
Divorce
Alcohol / Drug Addiction
Slide25:
Chernobyl 1:23 AM
Bhopal 12:40 AM
Three Mile Island 4:00 AM
Error Rate vs Time of Day: Error Rate vs Time of Day
Car Crashes vs Time of Day: Car Crashes vs Time of Day
Federal Regulations for Truckers: Federal Regulations for Truckers 10 hour maximum without break
15 hour max without 8 hour break
60 driving hours/7day period
Fatigue-Related Impairments: Fatigue-Related Impairments Passive vigilance
Reaction time
Hand-eye coordination
Clerical accuracy
Memory
Reasoning
Provider Fatigue vs Performance meta-analysis, resident physicians: Provider Fatigue vs Performance meta-analysis, resident physicians Sleep debt < 30 hrs
Overall performance reduced 1 std deviation
Clinical Performance reduced 1.5 std deviation
Philibert
Provider Fatigue vs Performance Outcomes: attention and simulated driving: Provider Fatigue vs Performance Outcomes: 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
Provider Fatigue vs Alcohol effects on performance: 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”
Provider Fatigue and Medical Errors: 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)
Physiology of Sleep: Physiology of Sleep
Circadian cycling promotes the acquisition of regular and adequate sleep: Circadian cycling promotes the acquisition of regular and adequate sleep
Overcoming this intrinsic biological predisposition is very, very difficult
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 Circadian Timekeeping
Circadian Rhythms: 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
Suprachiasmatic Nucleus : Suprachiasmatic Nucleus Locus of biologic rhythmicity
Neurons have circadian rhythmicity that is intracellular in origin
Genes coding for the clock function have been identified
Slide40: Body Temperature Cycle Sleep 8 12 16 20 MN 4 8 97 99 Hour 8 12 16 20 0 4 8 sleep O F 97 98 99
Measures of alertness track closely with body temperature, with nadirs is the very early morning: Measures of alertness track closely with body temperature, with nadirs is the very early morning
Mean Leg Strength after westward flight across 5 time zones: Mean Leg Strength after westward flight across 5 time zones
Sleep Architecture: Sleep Architecture Stage 1– if awakened people say they weren’t 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
Stages 3 - 4 (Slow wave or delta sleep - SWS) : 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
REM (“brain on, body off”) : REM (“brain on, body off”) Rapid eye movements
Wakeful EEG pattern
Increased cerebral blood flow
Absent spinal reflexes
Slide47: Sleep Architecture 1 2 3 4 5 6 7 8 W 1 2 3+4 REM 75% SWS 75% REM (SWS)
Slow Wave Sleep deprivation is associated with reduction in cognitive performance: Slow Wave Sleep deprivation is associated with reduction in cognitive performance
REM Deprivation: REM Deprivation Moodiness
Hypersensitivity
Inability to consolidate complex learning
REM appears to be important for psychological well-being
Sleep Debt: Sleep Debt Sleep latency can be measured
Very poor correlation between self-reported sleepiness and objective measures of fatigue
Variability in Sleep Requirements: Variability in Sleep Requirements > 7 1/2 hours is optimal for most adults
Tolerance of sleep deprivation varies
“Night owls” vs “early birds”
Light and Melatonin : 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
Bright lighting can reduce fatigue for workers forced to work at night: Bright lighting can reduce fatigue for workers forced to work at night
Sedative-Hypnotics: Sedative-Hypnotics Alcohol causes sleep fragmentation and decreased REM
Most sedative-hypnotics disrupt the architecture of sleep
Age Effects : 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?
Circadian Adjustment : 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
Short-term Countermeasures: Short-term Countermeasures
Strategic Napping : 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)
Napping: 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)
Interventions - caffeine ‘World’s most popular drug’: Interventions - caffeine ‘World’s 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
Do you know what dose you’re taking?: Do you know what dose you’re taking? No-Doz max strength
Brewed Coffee (average)
Excedrin (2)
Instant Coffee
Mountain Dew
Orange Pekoe Tea
Coke Classic
Hershey’s Dark Chocolate
Green Tea
Hershey’s 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
Modafinil “Provigil”: Modafinil “Provigil” Narcolepsy
Obstructive Sleep Apnea
Military “short-term fatigue countermeasure”
Shift Work Sleep Disorder
The only way to completely reverse the physiologic need for sleep is to sleep : The only way to completely reverse the physiologic need for sleep is to sleep
Summary: Summary The evidence that fatigue impairs human performance is incontrovertible
Physicians are human
Fatigue is a root cause of many medical errors
Summary: 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
References: Naska A, Oikonomou E, Trichopoulou A. Siesta in healthy adults and coronary mortality in the general population. Arch Intern Med 167:296, 2007.
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.
Philibert I. Sleep loss and performance in residents and nonphysicians: a meta-analytic examination. Sleep 28(11):1392, 2005.
Arnedt JT, Owens J, et al. Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion. JAMA 294(9):1025, 2005.
Dawson D, Reid K. Fatigue, alcohol and performance impairment. Nature 388(6639):235, 1997.
Taffinder NJ, McManus IC, Gul Y, et al. Effect of sleep deprivation on surgeons’ dexterity on laparoscopy simulator. Lancet 1191:352, 1998.
Leape LL, Brennan TA, Laird N, et al. The nature of adverse events in hospitalized patients. NEJM 324(6):377-384, 1991.
Institute of Medicine, To Err is Human, National Academy Press 2000, Washington, D.C., p 49.
Kaushal R, Bates DW, Landrigan C, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA 285:2114-2120, 2001.
Kozer E, Scolnik D, Macpherson A, et al. Variables associated with medication errors in pediatric emergency medicine. Pediatrics 110(4):737-742, 2002. References
References: Dement WC. The Promise of Sleep, Delacorte Press, NY 1999, p262-263.
Akerstedt T, Knutsson a, AlfredssonL, et al. Shift work and cardiovascular disease. Scand J Work Environ Health 10:490, 1984.
Earnest DJ, Liang F, Ratcliff M, et al. Immortal time: Circadian clock properties of rat suprachiasmatic cell lines. Science 283(5404):693, 1999.
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.
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.
Weitman ED, Moline ML, et al. Chronobiology of aging: Temperature, sleep-wake rhythms and entrainment. Neurobiol Aging 3:299-309, 1982.
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.
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.
van Duinen H, Lorist MM, Zijdewind I. The effect of caffeine on cognitive task performance and motor fatigue. Psychopharmacology. 180(3):539-47, 2005.
Czeisler CA, Walsh JK, Roth T, et al. Modafinil for excessive sleepiness associated with shift-work sleep disorder. NEJM 353(5):476, 2005. References
Slide68: Amy Fahrenkopf, MD, MPH
Pediatric Hospitalist
Children’s Hospital Boston
Boston, Massachusetts
Effects of Housestaff Burnout and Depression on Patient Safety: 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
Children’s Hospital Boston
Introduction: 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.
Burnout: Definition: 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 individual’s life
Burnout: Screening: 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
Burnout in Residency: What do we know?: Burnout in Residency: What 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%
Burnout in Residency: What do we know?: Burnout in Residency: What 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
Depression: Definition and Screening: 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
Depression in Residency: What do we know?: 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
Depression in Residency: What do we know?: 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
Depression and Burnout: Is there a link to medical errors?: Depression and Burnout: Is 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
Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program Shanafelt TD, Bradley KA, Wipf JE, Back AL; Ann Intern Med. 2002; 136:358-367 : Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program Shanafelt TD, Bradley KA, Wipf JE, Back AL; Ann Intern Med. 2002; 136:358-367 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
Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program Shanafelt TD, Bradley KA, Wipf JE, Back AL; Ann Intern Med. 2002; 136:358-367 : Burnout and Self-Reported Patient Care in an Internal Medicine Residency Program Shanafelt TD, Bradley KA, Wipf JE, Back AL; Ann Intern Med. 2002; 136:358-367 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%; p=0.004)
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])
Association of Perceived Medical Errors with Resident Distress and Empathy West CP, Huschka MM, Novotny PJ, et. al. JAMA. 2006; 296:1071-1078: Association of Perceived Medical Errors with Resident Distress and Empathy West CP, Huschka MM, Novotny PJ, et. al. JAMA. 2006; 296:1071-1078 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
Association of Perceived Medical Errors with Resident Distress and Empathy West CP, Huschka MM, Novotny PJ, et. al. JAMA. 2006; 296:1071-1078: Association of Perceived Medical Errors with Resident Distress and Empathy West CP, Huschka MM, Novotny PJ, et. al. JAMA. 2006; 296:1071-1078 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, p<0.001; EE+6.85, p<0.001; PA –2.99, p=0.001)
Association of Perceived Medical Errors with Resident Distress and Empathy West CP, Huschka MM, Novotny PJ, et. al. JAMA. 2006; 296:1071-1078: Association of Perceived Medical Errors with Resident Distress and Empathy West CP, Huschka MM, Novotny PJ, et. al. JAMA. 2006; 296:1071-1078 Self-perceived errors associated with odds ratio of 3.29 (95%CI, 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
Rates of Medication Errors Among Depressed and Burned Out House Officers Fahrenkopf AM, Sectish TC, Barger LK, et.al (Presented at ): Rates of Medication Errors Among Depressed and Burned Out House Officers Fahrenkopf AM, Sectish TC, Barger LK, et.al (Presented at ) Prospective cohort study of 123 pediatrics residents at 3 large Children’s Hospitals:
Children’s Hospital Boston
Lucile Packard Children’s Hospital
Children’s 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
Housestaff Burnout and Depression: The Link to Patient Safety Fahrenkopf AM, Sectish TC, Barger LK, et.al. Platform presentation, Agency for Healthcare Research and Quality Patient Safety Conference, Washington D.C., 2006 : Housestaff Burnout and Depression: The Link to Patient Safety Fahrenkopf 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
Housestaff Burnout and Depression: The Link to Patient Safety Fahrenkopf AM, Sectish TC, Barger LK, et.al. Platform presentation, Agency for Healthcare Research and Quality Patient Safety Conference, Washington D.C., 2006: Housestaff Burnout and Depression: The Link to Patient Safety Fahrenkopf 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
Housestaff Burnout and Depression: The Link to Patient Safety Fahrenkopf AM, Sectish TC, Barger LK, et.al. Platform presentation, Agency for Healthcare Research and Quality Patient Safety Conference, Washington D.C., 2006: Housestaff Burnout and Depression: The Link to Patient Safety Fahrenkopf AM, Sectish TC, Barger LK, et.al. Platform presentation, Agency for Healthcare Research and Quality Patient Safety Conference, Washington D.C., 2006 depressed burned out ‡‡‡ Errors per resident-month Depression, Burnout, and Medication Errors per Resident-Month
Housestaff Burnout and Depression: The Link to Patient Safety Fahrenkopf AM, Sectish TC, Barger LK, et.al. Platform presentation, Agency for Healthcare Research and Quality Patient Safety Conference, Washington D.C., 2006: Housestaff Burnout and Depression: The Link to Patient Safety Fahrenkopf AM, Sectish TC, Barger LK, et.al. Platform presentation, Agency for Healthcare Research and Quality Patient Safety Conference, Washington D.C., 2006 ‡p<0.05 ‡‡ p<0.01 ‡‡‡p<0.001 ‡ ‡ Depression, Burnout, and Self-reported Medical Errors
Areas for Further Research: 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.
Conclusion: 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
Conclusion: 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
Acknowledgements: Acknowledgements Pediatric Work Hours Study Group
Harvard Work Hours, Health and Safety Group
Christopher Landrigan, MD, MPH