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Stanford study shows role of physician burnout in medical errors

A new study examined the role of physician burnout in medical errors.

I knew physician burnout was a problem, but I didn't realize just how serious it was until writing a press release on a Stanford-led study on the topic. The research, published today in the Mayo Clinic Proceedings, links physician burnout to medical errors. As Daniel Tawfik, MD, lead author of the study, told me:

Up until just recently, the prevailing thought was that if medical errors are occurring, you need to fix the workplace safety with things like checklists and better teamwork. This study shows that that is probably insufficient. We need a two-pronged approach to reduce medical errors that also addresses physician burnout.

Physician burnout, which is characterized by emotional exhaustion, cynicism and inefficiency, has reached epidemic proportions now affecting 50 percent of all United States physicians, according to multiple studies. Medical errors, as well, are common across the nation, with studies estimating these errors are responsible for 100,000 to 200,000 deaths each year.

To examine the link between the two, researchers in this study sent surveys to physicians across the U.S. Among the 6,695 who responded, 3,574 or 55 percent, reported symptoms of burnout and 10 percent of those reported at least one major medical error in the past three months. They also ranked safety levels of the health care settings where they worked.

"We found that physicians with burnout had more than twice the odds of self-reported medical error, after adjusting for specialty, work hours, fatigue and work unit safety rating," said Tawfik, an instructor in pediatric critical care medicine. "We also found that low safety grades in work units were associated with three to four times the odds of medical error."

"This indicates both the burnout level as well as work unit safety characteristics are independently related to the risk of errors," added Tait Shanafelt, MD, senior author of the study and a national expert on the topic of physician wellness.

The researchers also found that rates of medical errors tripled in medical work units, even those ranked as extremely safe, if physicians working on that unit had high levels of burnout.

Shanafelt, director of the Stanford WellMD Center and author of more than 120 studies on the topic of physician burnout, noted that while most organizations invest substantial resources to improve safety in work units, "very few devote equal attention to address the system-level factors that drive burnout in the physicians and nurses working in that unit."

Addressing burnout is critical to creating "the high-quality health care system we aspire to," he said.

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