Sleep Disturbance and Burnout in Emergency Department Health Care Workers.
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ABSTRACT:
SUBMITTER: Shechter A
PROVIDER: S-EPMC10625040 | biostudies-literature | 2023 Nov
REPOSITORIES: biostudies-literature
Publications
Sleep Disturbance and Burnout in Emergency Department Health Care Workers.
Shechter Ari A Firew Tsion T Miranda Maody M Fray Nakesha N Norful Allison A AA Gonzalez Alvis A Chang Bernard P BP
JAMA network open 20231101 11
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Project description:IntroductionEmergency medicine (EM) physicians and trainees report high levels of burnout. Burnout negatively impacts physician well-being and career satisfaction but it remains unclear how burnout may influence patient care. We examined the degree to which EM trainee burnout at one institution was associated with patients' satisfaction with their emergency department (ED) care.MethodsIn this cross-sectional, pilot study conducted at a single institution, we measured EM trainee burnout using the Maslach Burnout Inventory through a confidential, electronic survey. We subsequently linked individual trainee burnout results with their individual Press Ganey (PG) ED patient satisfaction scores. We compared burnout scores across sex and postgraduate year using chi-square tests and PG results via analysis of variance.ResultsTwenty-seven of 53 (50.9%) eligible EM trainees completed the burnout assessment. Trainees reported an overall burnout rate of 77.8% (95% confidence interval = 59.2%-89.4%). There were no significant differences in burnout based on sex (p = 0.888) or postgraduate year (p = 0.671). Trainee burnout was significantly associated with lower trainee-specific PG scores, including patient ratings of resident physician courtesy (p = 0.011), taking the time to listen (p = 0.004), keeping informed of treatment (p = 0.014), and concern for patient comfort (p = 0.006). There was no significant association between trainee burnout and patients' overall likelihood to recommend the ED to others (p = 0.364).ConclusionEmergency medicine trainee burnout is associated with lower trainee-specific PG ED patient satisfaction scores across all four physician domains. In addition to its detrimental impact on physician wellness, burnout may play a significant adverse role in patients' perceptions of their ED providers' interpersonal and communication skills.
| S-EPMC6001511 | biostudies-literature
Project description:ObjectivesTo evaluate effectiveness of a community health worker (CHW) program designed to address client objectives among frequent emergency department (ED) users.DesignProgram evaluation using secondary analysis of client objectives from program records. Client objectives were characterized according to the World Health Organization's social determinants of health framework. Hierarchical generalized linear modeling was used to assess factors associated with objective achievement.SettingAn ED and the surrounding community in an economically disadvantaged area of Buffalo, New York.ParticipantsA total of 1600 adults over age 18 eligible for Medicaid and/or Medicare and who had at least 2 ED visits in the prior year.InterventionClients worked with CHWs in the community to identify diverse needs and objectives. Community health workers provided individualized services to help achieve objectives.Main outcome measureAchievement of client-focused objectives.ResultsMost objectives pertained to linkage to community resources and health care navigation, emphasizing chronic medical conditions and connection to primary care. Clients and CHWs together achieved 43% of total objectives. Objective achievement was positively associated with greater client engagement in CHW services.ConclusionsLow objective achievement may stem from system- and policy-level barriers, such as lack of affordable housing and access to primary care. Strategies for improving client engagement in CHW services are needed. Community health workers and their clients were most successful in areas in which public health policies and systems made resources easy to access or where the program had formalized relationships with resources, such as primary care.
| S-EPMC5794249 | biostudies-literature
Project description:Of 193 emergency department workers exposed to severe acute respiratory syndrome (SARS), 9 (4.7%) were infected. Pneumonia developed in six workers, and assays showed anti-SARS immunoglobulin (Ig) M and IgG. The other three workers were IgM-positive and had lower IgG titers; in two, mild illness developed, and one remained asymptomatic.
| S-EPMC3323160 | biostudies-literature
Project description:We explored the mediating role of burnout on the association between EDW and sleep disturbances. Our study included 18,744 Korean workers. Respondents were grouped into four levels (none, low, moderate, and high) based on their exposure to two EDW factors: handling angry clients (HAC) and hiding emotion (HE). Mediation models were used to estimate odds ratios (OR) at a 95% confidence interval (CI). Compared to those not exposed, low, moderate, and high HAC increased odds of sleep disturbance by 1.52 (95% CI 1.30-1.78), 3.20 (95% CI 2.57-3.98), and 3.28 (95% CI 2.77-3.88) times, respectively. The indirect effect via burnout accounted for 29.9%, 24.1%, and 23.6% of the total effect, respectively, with estimates of 1.13 (95% CI 1.11-1.16), 1.32 (95% CI 1.26-1.39), and 1.32 (95% CI 1.27-1.37). Low, moderate, and high HE increased the odds of sleep disturbance by 1.45 (95% CI 0.93-2.28), 2.38 (95% CI 1.57-3.61), and 3.14 (95% CI 2.08-4.71) times, respectively. The indirect effect via burnout accounted for 10.5%, 29.7%, and 33.1% of the total effect, with estimates of 1.04 (95% CI 0.98-1.10), 1.29 (95% CI 1.22-1.37), and 1.46 (95% CI 1.38-1.55), respectively. Effective policies are required to protect the psychological wellbeing of workers who frequently engage in interpersonal tasks.
| S-EPMC10550909 | biostudies-literature
Project description:BackgroundThe well-documented shortages of health care workers (HCWs) in sub-Saharan Africa are further intensified by the increased human resource needs of expanding HIV treatment programs. Burnout is a syndrome of emotional exhaustion (EE), depersonalization (DP), and a sense of low personal accomplishment (PA). HCWs' burnout can negatively impact the delivery of health services. Our main objective was to examine the prevalence of burnout amongst HCWs in Malawi and explore its relationship to self-reported suboptimal patient care.MethodsA cross-sectional study among HCWs providing HIV care in 89 facilities, across eight districts in Malawi was conducted. Burnout was measured using the Maslach Burnout Inventory defined as scores in the mid-high range on the EE or DP subscales. Nine questions adapted for this study assessed self-reported suboptimal patient care. Surveys were administered anonymously and included socio-demographic and work-related questions. Validated questionnaires assessed depression and at-risk alcohol use. Chi-square test or two-sample t-test was used to explore associations between variables and self-reported suboptimal patient care. Bivariate analyses identified candidate variables (p < 0.2). Final regression models included variables with significant main effects.ResultsOf 520 HCWs, 62% met criteria for burnout. In the three dimensions of burnout, 55% reported moderate-high EE, 31% moderate-high DP, and 46% low-moderate PA. The majority (89%) reported engaging in suboptimal patient care/attitudes including making mistakes in treatment not due to lack of knowledge/experience (52%), shouting at patients (45%), and not performing diagnostic tests due to a desire to finish quickly (35%). In multivariate analysis, only burnout remained associated with self-reported suboptimal patient care (OR 3.22, [CI 2.11 to 4.90]; p<0.0001).ConclusionBurnout was common among HCWs providing HIV care and was associated with self-reported suboptimal patient care practices/attitudes. Research is needed to understand factors that contribute to and protect against burnout and that inform the development of strategies to reduce burnout.
| S-EPMC5821338 | biostudies-literature
Project description:ImportanceBurnout is a pervasive, unrelenting problem among health care workers (HCWs), with detrimental impact to patients. Data on the impact of burnout on workforce staffing are limited and could help build a financial case for action to address system-level contributors to burnout.ObjectiveTo explore the association of burnout and professional satisfaction with changes in work effort over 24 months in a large cohort of nonphysician HCWs.Design, setting, and participantsThis longitudinal cohort study was conducted in Rochester, Minnesota; Scottsdale and Phoenix, Arizona; Jacksonville, Florida; and community-based hospitals and health care facilities in the Midwest among nonphysician HCWs who responded to 2 surveys from 2015 to 2017. Analysis was completed November 25, 2020.ExposuresBurnout, as measured by 2 items from the Maslach Burnout Inventory, and professional satisfaction.Main outcomes and measuresThe main outcome was work effort, as measured in full-time equivalent (FTE) units, recorded in payroll records.ResultsData from 26 280 responders (7293 individuals aged 45-54 years [27.8%]; 20 263 [77.1%] women) were analyzed. A total of 8115 individuals (30.9%) had worked for the organization more than 15 years, and 6595 individuals (25.1%) were nurses. After controlling for sex, age, duration of employment, job category, baseline FTE, and baseline burnout, overall burnout (odds ratio [OR], 1.53; 95% CI, 1.38-1.70; P < .001), high emotional exhaustion at baseline (OR, 1.54; 95% CI, 1.39-1.71; P < .001), and high depersonalization at baseline (OR, 1.40; 95% CI, 1.21-1.62; P < .001) were associated with an HCW reducing their FTE over the following 24 months. Conversely, satisfaction with the organization at baseline was associated with lower likelihood of reduced FTE (OR, 0.73; 95% CI, 0.65-0.83; P < .001). Findings were similar when emotional exhaustion (OR per 1-point increase, 1.12; 95% CI, 1.10-1.16; P < .001), depersonalization (OR per 1-point increase, 1.10; 95% CI, 1.06-1.14; P < .001) and satisfaction with the organization (OR per 1-point increase, 0.83; 95% CI, 0.79-0.88; P < .001) were modeled as continuous measures. Nurses represented the largest group (1026 of 1997 nurses [51.4%]) reducing their FTE over the 24 months.Conclusions and relevanceThis cohort study found that burnout and professional satisfaction of HCWs were associated with subsequent changes in work effort over the following 24 months. These findings highlight the importance of addressing factors contributing to high stress among all HCWs as a workforce retention and cost reduction strategy.
| S-EPMC8379653 | biostudies-literature
Project description:BackgroundUnmet dental need shares many risk factors with unmet health-related social needs (HRSN) such as housing and food security and are a common cause for seeking treatment at the emergency department (ED).MethodsThe authors recruited a purposive sample of English-speaking and Spanish-speaking patients, ED clinicians at 3 urban EDs, and dentists from nearby communities to participate in qualitative interviews to explore barriers to and facilitators of screening for HRSN and unmet dental needs in the ED. Themes were identified from transcripts using a modified grounded theory approach.ResultsInterviews were conducted with 25 ED patients, 19 ED clinicians, and 4 dentists. Four themes were identified: (1) a preference for formalized resources, which more frequently exist for HRSN than for oral health; (2) frequent use of ad hoc resources that are less reliable or structured, particularly for dental referral information; (3) limited knowledge of oral health care resources in the community; and (4) desire for more assistance with identifying and addressing resource needs for both HRSN and oral health. Patients were amenable to screening through a variety of modalities and felt it would be helpful, but clinicians emphasized the need for easier referral processes because of frequent failure to connect patients to oral health care.ConclusionsMore robust infrastructure and clinician support are needed to ensure successful referral and screening without undue provider burden for both medical and dental clinicians.Practical implicationsPatients are amenable to screening for unmet oral health needs and HRSN in the ED, which may improve access to care.
| S-EPMC10823431 | biostudies-literature
Project description:Background: Sleep disturbances are common after traumatic events and have been hypothesized to be a risk factor in the development of psychopathology such as that associated with posttraumatic stress disorder (PTSD). Objective: To assess the association between intrusive memories, a core clinical feature of PTSD, and self-reported sleep disturbance shortly after experiencing or witnessing a motor vehicle accident, and whether a brief behavioural intervention (trauma reminder cue and Tetris gameplay) reduced sleep disturbance post-trauma. Method: The exploratory analyses included 71 participants (mean age 39.66, standard deviation 16.32; 37 women, 52.1%) enrolled in a previously published proof-of-concept randomized controlled trial. Participants were recruited from the emergency department after experiencing or witnessing a traumatic motor vehicle accident. Intrusive memories were assessed with a daily paper-and-pen diary for one week post-trauma, and sleep disturbances with three questions from the Impact of Event Scale-Revised assessing problems initiating sleep, problems maintaining sleep and dreams about the event at one week and one month post-trauma. Missing data were imputed 15 times. Results: The total number of intrusive memories during the first week post-trauma suggested weak to moderate pooled intercorrelations with problems initiating and maintaining sleep. An ordinal regression using imputed data suggested that the intervention had no effect on sleep disturbances, while completers only analyses suggested an improvement in problems maintaining sleep at one week. Conclusions: This exploratory study suggested that experiencing early intrusive memories is related to sleep disturbances. Sleep disturbance might be a particularly important construct to assess in studies involving intrusive memories post-trauma.
| S-EPMC6338269 | biostudies-literature
Project description:OBJECTIVE:To examine the impact of integrating behavioral health services using the primary care behavioral health (PCBH) model on emergency department (ED) utilization. DATA SOURCES:Utilization data from three Dane County, Wisconsin hospitals and four primary care clinics from 2003 to 2011. STUDY DESIGN:We used a retrospective, quasi-experimental, controlled, pre-post study design. Starting in 2007, two clinics began integrating behavioral health into their primary care practices with a third starting in 2010. A fourth, nonimplementing, community clinic served as control. Change in emergency department and primary care utilization (number of visits) for patients diagnosed with mood and anxiety disorders was the outcomes of interest. DATA COLLECTION:Retrospective data were obtained from electronic patient records from the three main area hospitals along with primary care data from participating clinics. PRINCIPAL FINDINGS:Following the introduction of the PCBH model, one clinic experienced a statistically significant (p < .01, 95 percent CI 6.3-16.3 percent), 11.3 percent decrease in the ratio of ED visits to primary care encounters, relative to a control site, but two other intervention clinics did not. CONCLUSIONS:The PCBH model may be associated with a reduction in ED utilization, but better-controlled studies are needed to confirm this result.
| S-EPMC6232427 | biostudies-literature
Project description:BackgroundDepression is one of the most common illnesses in the United States, with increased prevalence among people with lower socioeconomic status and chronic mental illness who often seek care in the emergency department (ED). We sought to estimate the rate and severity of major depressive disorder (MDD) in a nonpsychiatric ED population and its association with subsequent ED visits and hospitalizations.MethodsThis prospective cohort study enrolled a convenience sample of English-speaking adults presenting to an urban academic medical center ED without psychiatric complaints between January 1, 2015, and September 21, 2015. Patients completed a computerized adaptive depression diagnostic screen (CAD-MDD) and dimensional depression severity measurement test (CAT-DI) via tablet computer. Primary outcomes included number of ED visits and hospitalizations assessed from index visit until January 1, 2016. Negative binomial regression modeling was performed to assess associations between depression, depression severity, clinical covariates, and utilization outcomes.ResultsOf 999 enrolled patients, 27% screened positive for MDD. The presence of MDD conveyed a 61% increase in the rate of ED visits (incidence rate ratio [IRR] = 1.61, 95% confidence interval [CI] = 1.27 to 2.03) and a 49% increase in the rate of hospitalizations (IRR = 1.49, 95% CI = 1.06-2.09). For each 10% increase in MDD severity, there was a 10% increase in the relative rate of subsequent ED visits (IRR = 1.10, 95% CI = 1.04 to 1.16) and hospitalizations (IRR = 1.10, 95% CI = 1.02 to 1.18). Across the range of the severity scale there was over a 2.5-fold increase in the rate of ED visits and hospitalization rates.ConclusionsRates of depression were high among a convenience sample of English-speaking adult ED patients presenting with nonpsychiatric complaints and independently associated with increased risk of subsequent ED utilization and hospitalization. Standardized assessment tools that provide rapid, accurate, and precise classification of MDD severity have the potential to play an important role in identifying ED patients in need of urgent psychiatric resource referral.
| S-EPMC6690783 | biostudies-literature