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Perceived Work Demands and Emergency Department Crowding as Predictors of Objective Stress Among Emergency
Thomas W Britt1, Ronald G Pirrallo, Patrick J Rosopa
1From the Clemson University, Clemson, South Carolina (T.W.B., P.J.R., A.B., Z.K., C.B., K.R.); University of South Caroline School of Medicine-Greenville, South Carolina (R.G.P., E.H., P.M., M.F.); and Wake Forest University School of Medicine-Charlotte, Charlotte, North Carolina (L.A.F.).
Journal of Occupational and Environmental Medicine
|April 26, 2024
Summary
Emergency physician burnout is linked to increased stress from demanding shifts and overcrowding, not fatigue. Interventions targeting shift demands are crucial for reducing physician stress.
Area of Science:
- Emergency Medicine
- Occupational Health
- Psychoneuroendocrinology
Background:
- Emergency physician (EP) burnout is a significant concern in healthcare.
- Understanding shift-level factors contributing to burnout is essential for targeted interventions.
Purpose of the Study:
- To investigate the relationship between shift demands, stress, and fatigue in emergency physicians.
- To identify key determinants of stress and fatigue at the shift level.
Main Methods:
- A study involving 16 emergency physicians assessed 114 shifts before and during the COVID-19 pandemic.
- Salivary cortisol (stress indicator) and self-reported fatigue were measured pre- and post-shift.
- Shift demands and crowding (National Emergency Department Overcrowding Scale) were objectively assessed.
Main Results:
- Higher shift demands, increased overcrowding, and the pandemic were associated with elevated end-of-shift cortisol levels.
- Cortisol levels significantly increased with more demanding shifts and greater emergency department crowding.
- No significant association was found between these factors and self-reported fatigue.
Conclusions:
- Shift demands and objective stress indicators are linked, but not self-reported fatigue, in emergency physicians.
- Interventions aimed at reducing shift demands and stress are necessary to mitigate emergency physician burnout.
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