Frequency of Burnout, Sleepiness and Depression in Emergency Medicine Residents with Medical Errors in the Emergency Department

Alireza Aala, Jafar Tabrizi, Fatemeh Ranjbar, Samad Shams Vahdati, Neda Mohammadi


Aims: Medical error is a great concern of the patients and physicians. It usually occurs due to physicians’ exhaustion, distress and fatigue. In this study, we aimed to evaluate frequency of distress and fatigue among emergency medicine residents reporting a medical error.

Materials and Methods: The study population consisted of emergency medicine residents who completed an emailed questionnaire including self-assessment of medical errors, the Epworth Sleepiness Scale (ESS) score, the Maslach Burnout Inventory, and PRIME-MD validated depression screening tool.  

Results: In this survey, 100 medical errors were reported including diagnostic errors in 53, therapeutic errors in 24 and following errors in 23 subjects. Most errors were reported by males and third year residents. Residents had no signs of depression, but all had some degrees of sleepiness and burnout. There were significant differences between errors subtypes and age, residency year, depression, sleepiness and burnout scores (p<0.0001).  

Conclusion: In conclusion, residents committing a medical error usually experience burnout and have some grades of sleepiness that makes them less motivated increasing the probability of medical errors. However, as none of the residents had depression, it could be concluded that depression has no significant role in medical error occurrence and perhaps it is a possible consequence of medical error.


Keywords: Residents; Medical error; Burnout; Sleepiness; Depression

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Hayward RA, Hofer TP. Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer. JAMA. 2001;286:415–20.

Reasons J. Human error: models and management. BMJ. 2000;320(7237):768–770.

Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ. 2001;322:517–9.

Chaudhry SI, Olofinboba KA, Krumholz HM. Detection of errors by attending physicians on a general medicine service. J Gen Intern Med. 2003;18:595-600.

Baker GR, Norton PG, Flintoft V, Blais R, Brown A, Cox J, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ. 2004; 170:1678-1686.

Graf J, von den Driesch A, Koch KC, Janssens U. Identification and characterization of errors and incidents in a medical intensive care unit. Acta Anaesthesiol Scand. 2005;49:930-939.

Andrews LB, Stocking C, Krizek T, Gottlieb L, Krizek C, Vargish T, et al. An alternative strategy for studying adverse events in medical care. Lancet. 1997;349:309-313.

Leape LL, Brennan TA, Laird N, Lawthers AG, Localio AR, Barnes BA, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991; 324:377–384.

Thomas EJ, Studdert DM, Burstin HR, Orav EJ, Zeena T, Williams EJ, et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care. 2000; 38:261–271.

Mizrahi T. Managing medical mistakes: ideology, insularity, and accountability among internists-in-training. Soc Sci Med. 1984; 19:135-146.

Wu AW, Folkman S, McPhee SJ, Lo B. Do house officers learn from their mistakes? JAMA. 1991; 265:2089-2094.

Lockley SW, Cronin JW, Evans EE, Cade BE, Lee CJ, Landrigan CP, et al. Effects of reducing interns’ weekly work hours on sleep and attention failures. N Engl J Med. 2004; 351:1829-37.

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.

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.

Ozyurt A, Hayran O, Sur H. Predictors of burnout and job satisfaction among Turkish physicians. Q J Med. 2006; 99:161–9.

De Oliveira GS, Ahmed S, Stock MC, Harter RL, Almeida MD, Fitzgerald PC, et al. High incidence of burnout in academic chairpersons of anesthesiology: Should we be taking better care of our leaders? Anesthesiology. 2011; 114:181–93.

West CP, Huschka MM, Novotny PJ, Sloan JA, Kolars JA, Habermann TR, et al. Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study. JAMA. 2006; 296:1071-8.

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; 336:488-91.

Burroughs TE, Waterman AD, Gallagher TH, Waterman B, Adams D, Jeffe DB, et al. Patient concerns about medical errors in emergency departments. Acad Emerg Med. 2005; 12:57−64.

Shanafelt TD, Balch CM, Bechamps G, Russell T, Dyrbye L, Satele D, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010; 251:995-1000.

Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K. Nurse-staffing levels and the quality of care in hospitals. N Engl J Med. 2002; 346(22):1715–1722.

Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002; 288(16):1987–1993.

Shanafelt TD, Bradley KA,Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002; 135:358-67.

Bellini LM, BaimeM, Shea JA. Variation ofmood and empathy during internship. JAMA. 2002; 287:3143-6.

Gopal R, Glasheen JJ,Miyoshi TJ, Prochazka AV. Burnout and internal medicine resident work-hour restrictions. Arch Intern Med. 2005; 165:2595-600.

Goitein L, Shanafelt TD, Wipf JE, Slatore CG, Back AL. The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program. Arch Intern Med. 2005; 165:2601-6.

Wu AW. Medical error: the second victim. BMJ. 2000; 320:726-7.

West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA. 2009; 302:1294-300.

Komatsu H. Referenced data about the relationships between sleep loss and safety. J Sci Labour. 2003; 79:17–29 (in Japanese with English abstract).

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; 20:30-5.


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