In 2019, the World Health Organization categorized burnout as a syndrome resulting from chronic workplace stress that has not been successfully managed. While burnout was a concern before COVID-19, its onset has exacerbated the problem.
According to an ACEP October 2020 poll, 87% of emergency physicians reported feeling more stressed since the start of the pandemic, and 72% reported experiencing more burnout on the job.
On the surface, burnout may be classified as a workforce issue; however, its far-reaching effects can threaten patient safety. In fact, research suggests that physicians experiencing burnout are twice as likely to make a medical error. Burnout should absolutely be considered one of the root causes of medical error.
The Frequency & Cost of Medical Errors
Among medical errors, diagnostic error is one of the most important safety problems in healthcare today, particularly in the practice of emergency medicine. As outlined in our whitepaper, the frequency of diagnostic error is significantly underestimated by malpractice claims. In a recent publication from Johns Hopkins, the diagnostic error rate was 62% for spinal epidural abscess, 28% for aortic aneurysm and dissection, and 20% for pulmonary embolism. According to a recent Medscape poll, 26% of emergency physicians think they make a diagnostic error every shift.
Diagnostic errors are the leading type of paid medical malpractice claims filed against emergency physicians, costing approximately $288,000 per claim filed. Prior to the onset of COVID-19, the medical malpractice insurance marketplace was increasing premiums due to an increase in the frequency of high severity cases. In fact, the projected loss rate for hospital professional liability increased by 30% (Occupied Bed Equivalent from $2,960 in 2020 to $3,850 in 2021) and specifically increased by ~15% in emergency medicine (from $5.92 per patient visit in 2020 to $6.81 in 2021).
As a result of this market pressure, healthcare organizations are increasing their self-insured retention layer to lower their total cost of risk. In fact, large health systems (>$5B in gross revenue) increased their self-insured retention limits by 34.5% ($8.4M to $11.3M), and medium ($2B–$5B) and small (<$2B) health systems increased their limits by ~8%.
Key Takeaway: Health systems should elevate the priority of providing a system solution to help providers avoid medical errors in the face of intensifying burnout and the rising cost of liability.
Many articles have been written about how to increase physician wellness and prevent burnout, including one recently published on this blog by RSQ® Collaborative member Naim El-Aswad, MD. The Sullivan Group supports all efforts designed to improve physician wellness and remains hopeful that health systems across the country will continue to prioritize this initiative.
However, it is also critical to implement a system solution to prevent medical errors before the consequences of burnout further compromise patient safety.