Burnout and medical errors among American surgeons

The American College of Surgeons commissioned a self-reporting survey in June 2008 to measure burnout and quality of life among American surgeons. Researchers asked questions including emotional exhaustion, depersonalization and personal accomplishment and others.

Just under 8000 out of the 25,000 surgeons responded to the survey, overall 40% of the respondents said they were burnout, 9% of those responded said having made a major medical mistake in the last 3 months. Researchers found that those who said they had made an error also showed more signs of depression and emotional exhaustion, however it was not clear whether the distress led to more errors or the errors caused more distress. They also found that the number of overnight calls and hours worked were not associated with the errors reported.

The results were published online on November 23 in the Annals of Surgery. The authors said that " although surgeons do not appear more likely to make errors than physicians in other disciplines, errors made by surgeons may have more severe consequences for patients due to the intereventional nature of surgical practice".

Sources: "Burnout and Medical Errors Among American Surgeons"Annals of Surgery (f/t via Athens)

Preventing medical errors - punish the persistent offenders

American patient safety experts, Robert Wachter and Peter Pronovost wrote in this week’s NEJM that failure to hold clinicians accountable for patient safety is the main reason medical errors continue to happen in hospitals.

They said that the estimated 100,000 yearly deaths from healthcare-associated infections in the US “could be prevented by strict adherence to infection-control practices including hand hygiene”. In most hospitals in the US, hand-hygiene rates are between 30% and 70%, other safety practices such as using a checklist to reduce bloodstream infection, marking the surgical site to prevent wrong-site surgery and performing a preoperative “time-out” are frequently skipped by physicians.

The authors noted that 4000 wrong-site surgeries still occur each year in the US, but hospitals have been reluctant to punish the persistent offenders for financial reasons. They said that the tradition of weak enforcement of safety rules has led too many physicians to ignore them.

In many American hospitals, physicians can lose their staff privileges for failing to sign discharge summaries or operative notes, this is prompted by regulatory and financial requirements rather than patient safety.

The authors called for penalties on doctors and nurses who repeatedly fail to comply with patient safety measures in parallel with the “no blame” approach embraced by many healthcare providers.

They listed some suggested penalties for failure to adhere to safety practice, for example, healthcare workers who persistently fail the hand hygiene, would be required to undergo training and re-education and lose their staff privileges and loss of pay for a week. Repeated failings by surgeons to conduct a “time-out” prior to surgery would result in loss of access to the operating rooms for 2 weeks with loss of pay. Repeated failure to use and sign surgical lists when inserting catheters would be similarly punished.

Pronovost said finding a workable balance between no blame and individual accountability will be challenging but the right balance will save lives.

Source: "Balancing "No Blame" with Accountability in Patient Safety". NEJM 2009, 361(14):1401-1406

To err is human ...

Two US doctors made a documentary about the impact of medical errors by interviewing patients and families that had been affected by medical error and found that doctors and patients felt the same kind of guilt, fear and isolation after the medical errors occur.

"How can patients, families and clinicians move beyond these feelings and approach closure and forgiveness?" the authors wrote.

Read the free full text article : "Guilty, Afraid, and Alone — Struggling with Medical Error", NEJM 357(17):1682-1683.