The first study about the impact of medical errors on residents was recently published, demonstrating that real or perceived mistakes produce depression and can deteriorate a resident’s quality of life, foster emotional exhaustion, and erode empathy.¹ These effects, in turn, feed a cycle of distress that increase the risk for new mistakes and early burnout.

A total of 184 residents at the Mayo Clinic Rochester completed a series of self-assessment surveys every 3 months over a 3-year period to assess self-perceived medical errors and their impact on quality of life, burnout (measured by depersonalization, emotional exhaustion, and sense of low personal accomplishment), and depression (using a depression screening tool). The residents were also asked, “Are you concerned you have made any major medical errors in the last 3 months?”

Overall, 34% of the residents perceived that they had made at least 1 major medical mistake. During the course of the study 20% reported making 1 error, 6% reported 2 errors, and 8% reported 3 or more errors.

Two thirds of the residents who made at least 1 major medical error were diagnosed with depression compared with only one third of those who reported making no mistakes. Those making an error also had a significantly lower overall quality of life, increased depersonalization and emotional exhaustion, and reduced sense of personal accomplishment and empathy.

These effects often resulted in new errors. For each 1-point increase in depersonalization score (on a scale of 0 to 30), the risk of making another major medical error in the next 3 months increased by 7%. And for each 1-point increase in emotional exhaustion score (scale, 0-54), the risk of a future error increased by 10%.

A second study published in the same issue showed that 84% of residents were exceeding the work-hour limits established by the Accreditation Council for Graduate Medication Education in 2003,² which may have direct implications to the number of medical errors. This study indicates that in the year following the new duty-hour requirements, residents regularly reported exceeding those limits. Evidence from results of a 2004 study showed that cutting residents’ work hours reduced serious medical errors by about 22%.³ 

Other system-based interventions for reducing mistakes include controlling nosocomial infections and implementing measures to prevent falls among inpatients.¹ Using successful coping strategies can help mitigate the effects of errors on residents, and thus lessen the likelihood of subsequent errors.

References
1. West CP, Huschka MM, Novotny PJ, et al. Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA. 2006; 296:1071-1078.

2. Landrigan CP, Barger LK, Cade BE, et al. Interns’ compliance with Accreditation Council for Graduate Medication Education work-hour limits. JAMA. 2006; 296:1063-1070.

3. Landrigan CP, Rothschild JM, Cronin JW, et al. Effects of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med. 2004; 351:1838-1848.