Purpose A proposed reason for the unacceptably high rate of medical errors in today's hospitals is that fatigued resident physicians make more mental mistakes. In part because of this concern, the ACGME has imposed duty hours restrictions on all residents. Little is known about how stress impacts patient care. We hypothesized that residents with greater stress would more frequently report suboptimal patient care.
Methods For two consecutive years (2004 and 2005), research assistants surveyed residents working on our internal medicine inpatient teams following morning attending rounds. Both residents and interns were asked to complete a brief questionnaire, which included four questions to rate their current stress level (eg, this has been a stressful day, 1 = strongly disagree and 5 = strongly agree) and three questions to assess the impact of stress on their life and work (eg, indicate how fatigue has interfered with your work, 0 = does not interfere and 10 = completely interferes). Further, residents were asked if any patient care issues were not completed on that day, whether any medical errors affected a patient, and whether any of those resulted in suboptimal care. Data were analyzed using descriptive statistics and simple correlations to assess the association of stress ratings with the patient care variables.
Summary A total of 271 resident surveys were returned from 163 inpatient team days. The mean stress level across all four stress statements was 2.6 6 1.1 and the mean impact of that stress was 5.2 6 2.2 across the three impact of stress on life and work statements. Overall, 21% reported that they had omitted some aspect of patient care, 20% reported a medical error affected a patient on their team, and 8% reported resultant suboptimal care. Resident stress correlated highly with medical errors affecting patient care (p = .007) and marginally with suboptimal care (p = .09). Stress impacting life and work correlated highly with omitting certain patient care duties (p = .03), medical errors affecting patient care (p = .04), and suboptimal care (p = .04).
Conclusions Resident stress ratings are negatively associated with important patient care variables (omissions in patient care, medical errors, and suboptimal care). Perhaps more important than stress levels is the impact of that stress on an individual's life. With current ACGME regulations, some have suggested that resident stress and workload will increase given similar work duties but less available time. The impact of duty hours regulations must be closely monitored in our teaching hospitals in order to ensure a high level of patient care.
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