Burn-out and fatigue in a hospital can be harmful - to patients.
About 1 in 10 doctors reported that they had made a major medical error in the prior three months in a national survey of over 6,000 American doctors just published in Mayo Clinic Proceedings.
Just over half of the doctors surveyed reported being burned-out, and the study authors found that those doctors were twice as likely to report errors.
Medical errors are the third-leading cause of death in the United States, behind only heart disease and cancer, according to a BMJ study. The direct economic costs may be over $20 billion and the opportunity costs of losing over 250,000 workers a year could be around $200 billion a year.
The impact of medical errors has led medicine to take a page from aviation over the last decade or so, adopting practices such as checklists and flattening the hierarchies among doctors, nurses, and other clinicians in an effort to reduce medical errors. LifeWings has led the way on this adaptation, and proved in over 200 implementations that thoughtfully adapted aviation tools can eliminate harm.
In their analysis of the survey of the 6000 physicians, the authors checked to see if they could attribute the errors to a few bad apples. Instead, they found that error rates rose in line with fatigue levels. So even doctors who are only a little more tired are more dangerous to their patients.
This is why the teamwork training to flatten the hierarchies for commercial airline crews frequently started with a module on fatigue countermeasures. Team training is all about developing skills to effectively use human resources, and the best resource a pilot or a physician has in a team setting is themselves. It's really hard to have a great team when the team leaders are fatigued and not operating at the top of their game.
Some fatigue will always be present in both healthcare and aviation. It is the nature of the professions. Preventing fatigue from creating further mistakes is a function of a) having a great team that feels safe to crosscheck each other, and b) having team members who acknowledge the effects of fatigue and ask for that cross check, and c) having team members that practice fatigue countermeasures.
It is clear from the medical mishap data that these three things are not happening as often as they should. Until they do, we will continue to harm patients.