Assessment of Physician Sleep and Wellness, Burnout, and Clinically Significant Medical Errors

Abstract

Importance: Sleep-related impairment in physicians is an occupational hazard associated with long and sometimes unpredictable work hours and may contribute to burnout and self-reported clinically significant medical error.

Objective: To assess the associations between sleep-related impairment and occupational wellness indicators in physicians practicing at academic-affiliated medical centers and the association of sleep-related impairment with self-reported clinically significant medical errors, before and after adjusting for burnout.

Design, setting, and participants: This cross-sectional study used physician wellness survey data collected from 11 academic-affiliated medical centers between November 2016 and October 2018. Analysis was completed in January 2020. A total of 19 384 attending physicians and 7257 house staff physicians at participating institutions were invited to complete a wellness survey. The sample of responders was used for this study.

Exposures: Sleep-related impairment.

Main outcomes and measures: Association between sleep-related impairment and occupational wellness indicators (ie, work exhaustion, interpersonal disengagement, overall burnout, and professional fulfillment) was hypothesized before data collection. Assessment of the associations of sleep-related impairment and burnout with self-reported clinically significant medical errors (ie, error within the last year resulting in patient harm) was planned after data collection.

Results: Of all physicians invited to participate in the survey, 7700 of 19 384 attending physicians (40%) and 3695 of 7257 house staff physicians (51%) completed sleep-related impairment items, including 5279 women (46%), 5187 men (46%), and 929 (8%) who self-identified as other gender or elected not to answer. Because of institutional variation in survey domain inclusion, self-reported medical error responses from 7538 physicians were available for analyses. Spearman correlations of sleep-related impairment with interpersonal disengagement (r = 0.51; P < .001), work exhaustion (r = 0.58; P < .001), and overall burnout (r = 0.59; P < .001) were large. Sleep-related impairment correlation with professional fulfillment (r = -0.40; P < .001) was moderate. In a multivariate model adjusted for gender, training status, medical specialty, and burnout level, compared with low sleep-related impairment levels, moderate, high, and very high levels were associated with increased odds of self-reported clinically significant medical error, by 53% (odds ratio, 1.53; 95% CI, 1.12-2.09), 96% (odds ratio, 1.96; 95% CI, 1.46-2.63), and 97% (odds ratio, 1.97; 95% CI, 1.45-2.69), respectively.

Conclusions and relevance: In this study, sleep-related impairment was associated with increased burnout, decreased professional fulfillment, and increased self-reported clinically significant medical error. Interventions to mitigate sleep-related impairment in physicians are warranted.

Figure 1.. Mean Sleep-Related Impairment Level Among Trainees Compared With Attending Physicians, by Medical Practice Specialty

OBGYN indicates obstetrics and gynecology.

Figure 2.. Probability of Error That Resulted in Patient Harm, by Sleep-Related Impairment and Burnout Categories Among 7624 Physicians and Trainee Physicians

Sleep-related impairment was defined as a score of 16 or greater on the Sleep-Related Impairment Scale.

Figure 3.. Cycle of Sleep-Related Impairment in Medicine

Occupational sleep-related impairment has been associated with a reduced capacity for attention, which could contribute to the cycle illustrated in this figure, in which sleep deprivation from excessive work hours could lead to decreased efficiency, which consequently could contribute to increased work hours. Reciprocal associations between these are also possible, as indicated by the bidirectionality of the arrows in this figure.