Quick study: Pediatric resident depression associated with medical errors

How common are depression and burnout among pediatric residents at three U.S. children's hospitals? Do these conditions correlate with medical errors?

THE HISTORY: Medical resident training is an arduous and stressful experience characterized by a lack of sleep and little free time. Several studies have concluded that residents exhibit relatively high rates of depression (ranging from 7 to 56 percent) and burnout (ranging from 41 to 76 percent). However, few studies have sought to determine what effect these conditions may have on patient safety.

THIS STUDY surveyed 123 pediatric residents at three children's hospitals (Lucile Packard Children's Hospital, Children's Hospital Boston and Children's National Medical Center in Washington, DC). The participants logged their daily work and hours of sleep from mid-May through June 2003. They also completed a questionnaire to detect symptoms of depression and burnout - a condition characterized in the medical field as mental and emotional exhaustion and depersonalization. They were also asked to report medical errors they made during the study period. These self reports were compared to hospital-gathered data on medical errors from two (Packard Children's Hospital and Children's Hospital Boston) of the three institutions studied. The third (Children's National Medical Center) did not link errors with individual study participants, and so was not included in this arm of the study.

THE RESULTS: The researchers determined that 20 percent of the residents were depressed - nearly double the prevalence of depression in the general population - and 75 percent were experiencing burnout. Nearly half of the depressed participants appeared to be unaware of their depression and only a few were receiving treatment.

Depressed residents made six times as many medication errors as their non-depressed peers (1.55 per resident month vs. 0.25 per resident month). The 24 errors made by depressed residents included 12 potential adverse drug events (i.e., neglecting to specify the concentration or rate of delivery of an intravenous treatment) and 12 errors with little potential for harm (i.e., prescribing Tylenol for a patient without specifying the frequency at which it was to be given).

Although burned-out residents reported higher-than-average frequencies of medical errors, this perception was not supported by data collected by the hospitals.

WHY IT MATTERS: The study suggests that the mental health of care providers can be an important component of patient safety. Working to prevent depression and burnout, as well as identifying and treating those who suffer from the conditions, may improve patient care.

The data in the study were collected before July 2003, when the Accreditation Council for Graduate Medical Education mandated a limit of 80 hours per week for medical residents. Prior to this mandate, pediatric residents typically worked more than 100 hours per week. The reduction in the length of the work week may have alleviated some of the sleep deprivation and stress that have been associated with higher-than-normal rates of depression and burnout experienced by pediatric residents.

Paul Sharek, MD, MPH, the chief clinical patient safety officer at Packard Children's and assistant professor of pediatrics at the School of Medicine; and Theodore Sectish, MD, former director of the pediatric residency program at Packard Children's and a former associate professor of pediatrics at the School of Medicine are the fourth and second authors of the study. The first and last authors of the paper are from Harvard Medical School. Other authors are from Brigham and Women's Hospital in Boston and George Washington University Medical School in Washington, DC.

It was published online in the British Medical Journal on Feb. 7.