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What’s New in the
Patient Safety World
October 2022
Physician Burnout
and Patient Safety
Burnout has become a major problem among all healthcare
professionals. And burnout is a patient safety issue because several studies
have shown burnout is associated with more frequent patient safety events and
other quality of care issues. And the prevalence of burnout has accelerated significantly
in the COVID-19 era. A survey of US physicians found that 62.8% of physicians
had at least one manifestation of burnout in 2021 compared with 38.2% in 2020 (Shanafelt
2022). This trend was consistent across nearly all specialties, though
there was substantial variability by specialty. Satisfaction with work-life integration
declined from 46.1% in 2020 to 30.2% in 2021. Mean scores for depression
increased a modest 6.1%, suggesting to the authors that the increase in
physician distress was overwhelmingly work-related.
In our August 2018 What's
New in the Patient Safety World column “Burnout
and Medical Errors” we noted a study
published in the Mayo Clinic Proceedings (Tawfik
2018) showed that physicians
reporting symptoms of burnout were more than twice as likely to have reported a
major medical error in the prior 3 months. Now a systematic review and
meta-analysis (Hodkinson
2022) also found that physician burnout doubled patient safety incidents
compared with no patient safety incidents. Hodkinson et al. found that burnout
in physicians was associated with an almost four times decrease in job
satisfaction compared with increased job satisfaction (odds ratio 3.79) and
that turnover intention also increased by more than threefold compared with
retention (odds ratio 3.10). Burnout and patient safety incidents were greatest
in physicians aged 20-30 years, and people working in emergency medicine.
The editorial accompanying the Hodkinson study (Weigl 2022)
notes that work design and organization level interventions are often neglected
but are the key to meaningful progress on burnout.
Another survey of over 1300 US physicians (Menon
2020) found that each standard deviation-unit increase in burnout was
associated with an increase in self-reported medical errors (OR, 1.48).
Of course, burnout and its relationship to medical errors is
not limited to physicians. Melnyk et al. (Melnyk
2021), in a survey of critical care nurses, found that nurses in poor
physical and mental health reported significantly more medical errors than
nurses in better health. Nurses who perceived that their worksite was very
supportive of their well-being were twice as likely to have better physical
health. Their findings suggest that the worksite environment impacts burnout
and can lead to more medical errors.
Some of our prior
columns on “burnout”:
- August 2018 “Burnout
and Medical Errors”
- October 16, 2018 “Burnout”
- February 9, 2021 “Nursing Burnout”
- May 2021 “More on Time Spent on
the EMR”
References:
Shanafelt TD, West CP, Dyrbye LN, et al. Changes in Burnout and Satisfaction With Work-Life Integration in Physicians Over the First 2
Years of the COVID-19 Pandemic. Mayo Clinic Proceedings 2022; September 13,
2022
https://www.mayoclinicproceedings.org/article/S0025-6196(22)00515-8/fulltext#articleInformation
Tawfik DS, Profit J, Morgenthaler TI, et al. Physician
Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported
Medical Errors. Mayo Clinic Proceedings 2018; 93(11): 1571-1580 Published
online: July 9, 2018
https://www.mayoclinicproceedings.org/article/S0025-6196(18)30372-0/fulltext
Hodkinson A, Zhou, A, Johnson J, Geraghty K, Riley R, Zhou A
et al. Associations of physician burnout with career engagement and quality of
patient care: systematic review and meta-analysis. BMJ 2022; 378: e070442
https://www.bmj.com/content/378/bmj-2022-070442
Weigl M. Physician burnout
undermines safe healthcare. BMJ 2022; 378: o2157
https://www.bmj.com/content/378/bmj.o2157
Menon NK, Shanafelt TD, Sinsky CA, et al. Association of Physician Burnout With Suicidal Ideation and Medical Errors. JAMA Netw Open 2020; 3(12): e2028780
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773831
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773777
Melnyk BM, Tan A, Hsieh AP, et al. Critical Care Nurses’
Physical and Mental Health, Worksite Wellness Support, and Medical Errors. Am J
Crit Care 2021; 30 (3): 176-184
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