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Abstract:
Objectives: Burnout among physicians is an increasingly recognized phenomenon affecting different aspects of patient care and safety. This meta-analysis quantifies association of burnout and its subscales with self-reported medical errors among physicians. Methods: This meta-analysis followed the principles formulated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analyses of Observational Studies. The MEDLINE, PubMed, Web of Science, PsycInfo, and Eric databases were searched until February 5, 2019, using various combinations of key terms without any language restrictions: burnout, physicians, error, safety, and quality. Reference lists of selected studieswere hand searched. Datawere extracted frompublished reports. All quantitative studies reporting prevalence of burnout and its association with self-reported errors among physicians were considered. The analyses of heterogeneity (Cochran Q, I^2), publication bias (Begg- Mazumdar and Egger), three subgroups, and sensitivity were performed. The effect of overall burnout and Maslach Burnout Inventory subscales on self-reported errors was calculated as odds ratios with 95% confidence interval. Results: Thirteen studies on 20,643 physicians and residents were included. The overall burnout among participants was associated with a significantly increased risk of self-reported errors (odds ratio = 2.72, 95% confidence interval = 2.19–3.37). Emotional exhaustion, depersonalization, and personal accomplishment were all independently predicting factors of self-reported errors. Cochran Q test and inconsistency index I2 were as follows: Q = 27.2; P = 0.0013, I^2 = 67% (36%–83%). Conclusions: The results provide evidence that not only overall burnout but also its subscales independently are to be associated with a significantly increased risk of self-reported errors among physicians. As self-reported errors may translate into different types of adverse events, this strong and unequivocal association should be of major concern to healthcare organizations.

Keywords:
burnout, error, patient safety, quality of care

Abstract:
Introduction: In recent years, healthcare systems around the world have been subject to profound changes driven by advances in technology, new regulations as well as demographic and societal trends. This volatile and stressful environment has had its consequences for healthcare organizations and their employees. The resulting phenomena of burnout or lowered well-being may affect key aspects of healthcare delivery on individual, organizational, and financial levels. Objectives: The objective of this paper was to investigate the level of burnout and well-being in a group of Polish physicians, its impact on errors, and associations with other factors. Methods: This was a cross-sectional survey using a self-administered questionnaire with 65 questions and validated tools such as the Maslach Burnout Inventory and the World Health Organization–5 Well-being Index (WHO-5). Correlations between variables were investigated using Spearman rank correlation analysis. Univariable and multivariable logistic regression models were used to evaluate predictors of burnout and errors. The study included residents and physicians of various specialties. Results: A total of 125 residents and physicians, mostly internists and cardiologists, participated in the study, out of which 84 (67%) were found to be burned out. The median WHO-5 score was 40 points. Two-thirds of all physicians admitted to making an error in the last 3 months, which was strongly associated with burnout. Conclusions: The level of burnout among respondents was high and had numerous negative consequences that may affect the entire healthcare system. The results suggest there is an urgent need to address the problem of burnout among physicians.

Keywords:
burnout, errors, patient safety, suicidal ideation, well-being