Patient safety/original researchThe Effect of Clinical Experience on the Error Rate of Emergency Physicians
Introduction
A number of studies have examined the relationship of age and experience to professional performance. A study of pilots found that the ability to perform more than 1 task simultaneously diminished with age.1 In a variety of occupations, increasing exposure to nightshift work adversely affected cognitive performance.2 Increasing physician experience has in general been found to correlate negatively with medical knowledge, adherence to practice standards, and clinical outcomes.3 However, there are few data relating to the effect of experience and time on the skills and performance of emergency physicians.
The possible effect of cumulative experience and aging on performance is a critical issue for many professions, including the practice of medicine. If physicians' skills erode with time, then medical education resources should arguably be concentrated on more experienced and older clinicians. In addition, if such an effect were unremediated, there would be significant patient safety–based implications for practice longevity. If, however, “practice makes perfect,” then educational resources could be predominantly marshaled for resident education and in the early phase of physicians' practice lives.
Section snippets
Goals of This Investigation
We have accumulated a 7-year history of peer review records for a group of emergency physicians in a practice at a large urban teaching hospital. We analyzed physician performance as reflected by these records to determine the effect of clinical experience on the likelihood of a physician committing a patient care error. In doing so, we made the assumption that physician performance would be accurately reflected by error rate, corrected for number of patients treated with errors determined
Setting
The emergency department (ED) is part of Detroit Receiving Hospital, an urban university-affiliated teaching center with a mean annual census of 77,000 patients. The hospital facility specializes in emergency trauma and critical care, is an American College of Surgeons–verified Level I trauma center, and admits approximately 95% of its inpatients through the ED. The hospital is the site of a 3-year emergency medicine residency with 36 residents. Full-time and clinical faculty care for patients
Characteristics of Study Subjects
During the 7 years from 1999 to 2005, 75 emergency physicians treated 543,709 patients. The number of emergency physicians in any one year ranged from 39 to 46. A total of 302 emergency physician practice years were available for analysis, with each physician contributing a mean of 4.0±2.3 years. Figure 1 reflects the frequency of emergency physician experience during the 302 emergency physician practice years studied.
Weighted mean emergency physician experience calculated as the mean
Limitations
Our study has limitations. First, it was performed in an academic setting and as such our findings may not be applicable to other types of practice. Because a considerable proportion of patients are treated primarily by residents, the quality of supervision, as well as the quality of directly rendered care, is likely to have an effect on the propensity for error. Second, although all emergency physicians have their cases screened for the same review criteria, only a fraction of all cases are
Discussion
In contrast to other authors, we found no increase in the likelihood of making an error with increasing experience. On the contrary, it was the more experienced physicians who were about a third less likely to commit errors.
There are few data about the effect of clinical experience on the performance of emergency physicians. A study of adherence to guidelines for management of febrile infants by 474 emergency physicians, pediatricians, and family practitioners reported decreasing guideline
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Supervising editor: John C. Moorhead, MD, MS
Author contributions: WAB, PDL, BFB, and PJS conceived the study. WAB, RDW, PDL, GJK, BFB, and PJS designed the study. WAB designed the trial. WAB drafted the article. RDW, PDL, JTJ, CA, GJK, JJK, BFB, and PJS assisted in manuscript preparation. RDW provided statistical analysis and advice. JTJ, CA, and JJK were responsible for data collection and organization. WAB takes responsibility for the paper as a whole.
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.
Earn CME Credit: Continuing Medical Education is available for this article at: www.ACEP-EMedHome.com.
Publication dates: Available online March 19, 2008.
Reprints not available from the authors.