Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago IL.
Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA.
Ann Surg. 2021 Aug 1;274(2):396-402. doi: 10.1097/SLA.0000000000003909.
The aims of this study were to: (1) measure the prevalence of self-reported medical error among general surgery trainees, (2) assess the association between general surgery resident wellness (ie, burnout and poor psychiatric well-being) and self-reported medical error, and (3) examine the association between program-level wellness and objectively measured patient outcomes.
Poor wellness is prevalent among surgical trainees but the impact on medical error and objective patient outcomes (eg, morbidity or mortality) is unclear as existing studies are limited to physician and patient self-report of events and errors, small cohorts, or examine few outcomes.
A cross-sectional survey was administered immediately following the January 2017 American Board of Surgery In-training Examination to clinically active general surgery residents to assess resident wellness and self-reported error. Postoperative patient outcomes were ascertained using a validated national clinical data registry. Associations were examined using multivariable logistic regression models.
Over a 6-month period, 22.5% of residents reported committing a near miss medical error, and 6.9% reported committing a harmful medical error. Residents were more likely to report a harmful medical error if they reported frequent burnout symptoms [odds ratio 2.71 (95% confidence interval 2.16-3.41)] or poor psychiatric well-being [odds ratio 2.36 (95% confidence interval 1.92-2.90)]. However, there were no significant associations between program-level resident wellness and any of the independently, objectively measured postoperative American College of Surgeons National Surgical Quality improvement Program outcomes examined.
Although surgical residents with poor wellness were more likely to self-report a harmful medical error, there was not a higher rate of objectively reported outcomes for surgical patients treated at hospitals with higher rates of burnout or poor psychiatric well-being.
本研究旨在：(1) 测量普通外科住院医师报告的医疗差错发生率；(2) 评估普通外科住院医师的健康状况（即倦怠和心理健康不良）与自我报告的医疗差错之间的关系；(3) 检查计划层面的健康状况与客观测量的患者结果之间的关系。
手术培训生的健康状况不佳很常见，但对医疗差错和客观的患者结果（如发病率或死亡率）的影响尚不清楚，因为现有研究仅限于医生和患者对事件和差错的自我报告、小队列或检查少数结果。
在 2017 年 1 月美国外科委员会住院医师培训考试后，立即对临床活跃的普通外科住院医师进行横断面调查，以评估住院医师的健康状况和自我报告的差错。通过验证的全国临床数据登记系统确定术后患者的结局。使用多变量逻辑回归模型检查相关性。
在 6 个月的时间内，22.5%的住院医师报告发生了接近医疗差错，6.9%的住院医师报告发生了有害医疗差错。如果住院医师报告经常出现倦怠症状[比值比 2.71(95%置信区间 2.16-3.41)]或心理健康不良[比值比 2.36(95%置信区间 1.92-2.90)]，则更有可能报告有害的医疗差错。然而，在独立、客观测量的美国外科医师学会国家手术质量改进计划的任何术后结果中，计划层面的住院医师健康状况与任何结果之间均无显著相关性。
尽管健康状况不佳的外科住院医师更有可能自我报告有害的医疗差错，但在倦怠或心理健康不良发生率较高的医院接受治疗的外科患者的客观报告结果并没有更高的发生率。
