Associations of physicians' prescribing experience, work hours, and workload with prescription errors

Ilona Leviatan, Bernice Oberman, Eyal Zimlichman, Gideon Y. Stein

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: We aimed to assess associations of physician's work overload, successive work shifts, and work experience with physicians' risk to err. MATERIALS AND METHODS: This large-scale study included physicians who prescribed at least 100 systemic medications at Sheba Medical Center during 2012-2017 in all acute care departments, excluding intensive care units. Presumed medication errors were flagged by a high-accuracy computerized decision support system that uses machine-learning algorithms to detect potential medication prescription errors. Physicians' successive work shifts (first or only shift, second, and third shifts), workload (assessed by the number of prescriptions during a shift) and work-experience, as well as a novel measurement of physicians' prescribing experience with a specific drug, were assessed per prescription. The risk to err was determined for various work conditions. RESULTS: 1 652 896 medical orders were prescribed by 1066 physicians; The system flagged 3738 (0.23%) prescriptions as erroneous. Physicians were 8.2 times more likely to err during high than normal-low workload shifts (5.19% vs 0.63%, P < .0001). Physicians on their third or second successive shift (compared to a first or single shift) were more likely to err (2.1%, 1.8%, and 0.88%, respectively, P < .001). Lack of experience in prescribing a specific medication was associated with higher error rate (0.37% for the first 5 prescriptions vs 0.13% after over 40, P < .001). DISCUSSION: Longer hours and less experience in prescribing a specific medication increase risk of erroneous prescribing. CONCLUSION: Restricting successive shifts, reducing workload, increasing training and supervision, and implementing smart clinical decision support systems may help reduce prescription errors.

Original languageEnglish
Pages (from-to)1074-1080
Number of pages7
JournalJournal of the American Medical Informatics Association : JAMIA
Issue number6
StatePublished - 12 Jun 2021


  • adverse drug events
  • clinical decision support system
  • physician fatigue
  • prescription errors


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