Internal medicine residents who report higher levels of fatigue and emotional distress also report higher levels of major medical errors, according to a recent study reported in the Journal of the American Medical Association, (2009;302:1294-1300).

Although both fatigue and distress among physicians already have been identified as contributing factors to medical errors, this is the first study that looked at the combination of both. Researchers from the Mayo Clinic in Rochester, Minn., studied self-reported data from 380 internal medicine residents.

The residents filled out quarterly surveys to assess their fatigue, sleepiness, quality of life, burnout, and depression. Additionally, residents were asked to report whether they had made any major medical error in the past three months.

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Overall, 39% of the respondents reported making at least one major medical error doing the study period. Residents reporting at least one error had significantly lower overall quality of life, higher levels of burnout, increased emotional exhaustion, and lower sense of personal accomplishment. Almost 69% of residents reporting an error screened positive for depression at least once during the study period. A positive depression screen was associated with 2.56-fold greater likelihood of a self-reported error in the following three months.

Increased fatigue and sleepiness were associated with increased odds of reporting an error, whereas an increased quality of life was associated with a decrease in the odds. Researchers concluded that although reforms have been made to prevent excessive fatigue among residents, attention needs to be paid to the effects of emotional distress as well.

“Although distress may be more likely to develop after an extended burden of fatigue, these results suggest that distress can and does occur independent of fatigue,” the researchers wrote. “In summary, this study suggests that fatigue, sleepiness, burnout, depression, and reduced QOL are independently associated with an increased risk of future self-perceived major medical errors.”

To improve resident and patient safety, the authors concluded, changes to the process of physician training should address both resident fatigue and distress.