title: The Iatroref study: medical errors are associated with symptoms of depression in ICU staff but not burnout or safety culture.
abstract: OBJECTIVE
  Staff behaviours to optimise patient safety may be influenced by burnout, depression and strength of the safety culture. We evaluated whether burnout, symptoms of depression and safety culture affected the frequency of medical errors and adverse events (selected using Delphi techniques) in ICUs.
  
  
  METHODS
  Prospective, observational, multicentre (31 ICUs) study from August 2009 to December 2011.
  
  
  RESULTS
  Burnout, depression symptoms and safety culture were evaluated using the Maslach Burnout Inventory (MBI), CES-Depression scale and Safety Attitudes Questionnaire, respectively. Of 1,988 staff members, 1,534 (77.2 %) participated. Frequencies of medical errors and adverse events were 804.5/1,000 and 167.4/1,000 patient-days, respectively. Burnout prevalence was 3 or 40 % depending on the definition (severe emotional exhaustion, depersonalisation and low personal accomplishment; or MBI score greater than -9). Depression symptoms were identified in 62/330 (18.8 %) physicians and 188/1,204 (15.6 %) nurses/nursing assistants. Median safety culture score was 60.7/100 [56.8-64.7] in physicians and 57.5/100 [52.4-61.9] in nurses/nursing assistants. Depression symptoms were an independent risk factor for medical errors. Burnout was not associated with medical errors. The safety culture score had a limited influence on medical errors. Other independent risk factors for medical errors or adverse events were related to ICU organisation (40 % of ICU staff off work on the previous day), staff (specific safety training) and patients (workload). One-on-one training of junior physicians during duties and existence of a hospital risk-management unit were associated with lower risks.
  
  
  CONCLUSIONS
  The frequency of selected medical errors in ICUs was high and was increased when staff members had symptoms of depression.
authors.affiliation: Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France, mgarrouste@hpsj.fr.
authors.forename: Maité
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: Marion
authors.initials: M
authors.lastname: Perrin
authors.forename: Lilia
authors.initials: L
authors.lastname: Soufir
authors.forename: Aurélien
authors.initials: A
authors.lastname: Vesin
authors.forename: François
authors.initials: F
authors.lastname: Blot
authors.forename: Virginie
authors.initials: V
authors.lastname: Maxime
authors.forename: Pascal
authors.initials: P
authors.lastname: Beuret
authors.forename: Gilles
authors.initials: G
authors.lastname: Troché
authors.forename: Kada
authors.initials: K
authors.lastname: Klouche
authors.forename: Laurent
authors.initials: L
authors.lastname: Argaud
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000368:Aged; D002055:Burnout, Professional / Q000523:psychology*; D003863:Depression / Q000453:epidemiology*; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D019300:Medical Errors / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D015995:Prevalence; D011446:Prospective Studies; D012449:Safety; D011795:Surveys and Questionnaires; D016526:Workload / Q000523:psychology*