Association of Resident Fatigue and Distress With Occupational Blood and Body Fluid Exposures and Motor Vehicle Incidents

doi:10.1016/j.mayocp.2012.07.021

Mayo Clinic Proceedings

Volume 87, Issue 12, December 2012, Pages 1138-1144

https://doi.org/10.1016/j.mayocp.2012.07.021 Get rights and content

Abstract

Objective

To evaluate the effect of resident physicians' distress on their personal safety.

Participants and Methods

We conducted a prospective, longitudinal cohort study of internal medicine residents at Mayo Clinic in Rochester, Minnesota. Participants completed surveys quarterly from July 1, 2007, through July 31, 2011, during their training period. Frequency of self-reported blood and body fluid (BBF) exposures and motor vehicle incidents was recorded. Associations of validated measures of quality of life, burnout, symptoms of depression, fatigue, and sleepiness with a subsequently reported BBF exposure or motor vehicle incident were determined using generalized estimating equations for repeated measures.

Results

Data were provided by 340 of 384 eligible residents (88.5%). Of the 301 participants providing BBF exposure data, 23 (7.6%) reported having at least 1 BBF exposure during the study period. Motor vehicle incidents were reported by 168 of 300 respondents (56.0%), including 34 (11.3%) reporting a motor vehicle crash and 130 (43.3%) reporting a near-miss motor vehicle crash. Other than the low personal accomplishment domain of burnout, distress and fatigue at one time point exhibited no statistically significant associations with BBF exposure in the subsequent 3 months. However, diminished quality of life, burnout, positive screening for depression, fatigue, and sleepiness were each associated with statistically significantly increased odds of reporting a motor vehicle incident in the subsequent 3 months.

Conclusion

Exposures to BBF are relatively uncommon among internal medicine residents in current training environments. Motor vehicle incidents, however, remain common. Our results confirm the importance of fatigue and sleepiness to resident safety concerns. In addition, higher levels of distress may be contributory factors to motor vehicle crashes and other related incidents. Interventions designed to address both fatigue and distress may be needed to optimally promote patient and resident safety.

Section snippets

Study Participants

All categorical and preliminary internal medicine residents in the Mayo Clinic Rochester Internal Medicine Residency Program from July 1, 2007, through July 31, 2011, were invited to participate in this study. Program structure and study enrollment procedures have been detailed previously.¹¹ Written informed consent was obtained for all participants. The Mayo Clinic Institutional Review Board approved this study.

Data Collection

Residents were surveyed via e-mail every 3 months throughout the study period.

Results

Participants were 340 of 384 internal medicine residents (88.5%) in training at Mayo Clinic from July 1, 2007, through July 31, 2011. There were no statistically significant differences between participants and nonparticipants regarding age, sex, or program type. The demographic characteristics of study participants are displayed in Table 1. Of the participants, 301 (88.5%) completed at least 1 survey and 83 (24.4%) completed all surveys (up to 13 quarterly surveys) during the study period,

Discussion

The results of this 5-year, prospective, longitudinal cohort study confirm the importance of fatigue and sleepiness to resident safety concerns, particularly relating to motor vehicle incidents. In addition, however, higher levels of personal distress may also be contributory factors to MVCs and other motor vehicle incidents. These findings indicate that resident distress is related not only to patient safety and quality of care but to residents' personal safety as well.

Rates of BBF exposure

Conclusion

Exposures to BBF are relatively uncommon among internal medicine residents in current training environments. Motor vehicle incidents, however, remain common. Our results suggest that fatigue, sleepiness, burnout, depression, and reduced QOL are associated with an increased risk of future motor vehicle incidents. In addition to ongoing efforts to limit physician fatigue and sleepiness, interventions to promote well-being and reduce distress among physicians are needed to improve both patient and

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: See editorial comment, page 1135

: Grant Support: This work was supported by the Mayo Clinic Department of Medicine Program on Physician Well-being.

: Role of the Sponsor: The funding source played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation of the manuscript.

View full text

Original articleAssociation of Resident Fatigue and Distress With Occupational Blood and Body Fluid Exposures and Motor Vehicle Incidents

Abstract

Objective

Participants and Methods

Results

Conclusion

Section snippets

Study Participants

Data Collection

Results

Discussion

Conclusion

The well-being of physicians

Am J Med

Resident burnout

JAMA

Burnout and suicidal ideation among U.S. medical students

Ann Intern Med

Burnout and medical errors among American surgeons

Ann Surg

Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents

JAMA

Effect of reducing interns' work hours on serious medical errors in intensive care units

N Engl J Med

Impact of extended-duration shifts on medical errors, adverse events, and attentional failures

PLoS Med

Effects of health care provider work hours and sleep deprivation on safety and performance

Jt Comm J Qual Patient Saf

Making health care safer: a critical analysis of patient safety practices

Association of perceived medical errors with resident distress and empathy: a prospective longitudinal study

JAMA

Association of resident fatigue and distress with perceived medical errors

JAMA

Rates of medication errors among depressed and burnt out residents: prospective cohort study

BMJ

Burnout and self-reported patient care in an internal medicine residency program

Ann Intern Med

Is the professional satisfaction of general internists associated with patient satisfaction?

J Gen Intern Med

Resident Duty Hours: Enhancing Sleep, Supervision, and Safety

Extended work shifts and the risk of motor vehicle crashes among interns

N Engl J Med

Extended work duration and the risk of self-reported percutaneous injuries in interns

JAMA

Fatigue increases the risk of injury form sharp devices in medical trainees: results from a case-crossover study

Infect Control Hosp Epidemiol

Distinguishing between excessive daytime sleepiness and fatigue: toward improved detection and treatment

J Psychosom Res

Distinguishing sleepiness and fatigue: focus on definition and measurement

Sleep Med Rev

Original article
Association of Resident Fatigue and Distress With Occupational Blood and Body Fluid Exposures and Motor Vehicle Incidents