An adaptive simulation intervention decreases emergency physician physiologic stress while caring for patients during...

Stressful work environments and burnout in emergency medicine (EM) physicians adversely impact patient care quality. The future EM workforce will need to prioritize clinician well-being to ensure optimal patient care.

This prospective, randomized, controlled study aimed to determine whether an adaptive simulation intervention, COVID-19 Responsive Intervention: Systems Improvement Simulations (CRI:SIS), decreased physiologic stress as measured by heart rate variability (HRV) in front-line EM physicians during the COVID-19 pandemic. HRV was measured with smart shirts and self-reported State-Trait Anxiety Inventory (STAI) were collected at baseline and during four 8-hour clinical shifts for all participants. The intervention group (n = 40) received a 3-hour virtual educational simulation intervention consisting of four simulation scenarios (CRI:SIS). The control group (n = 41) received no simulation intervention.

There were no significant differences in demographics between groups. HRV data collected from 81 physicians across a total of 324 clinical shifts showed an increase in HRV (decrease in physiologic stress) in shifts immediately following CRI:SIS in the intervention group as measured by a root mean square standard deviation (RMSSD) difference of 11.55 ms (95% CI, -19.90 to -3.20; P = 0.007) compared to the control group. Post-intervention STAI did not significantly differ between intervention and control.

An adaptive simulation-based educational intervention led to decreased physiologic stress (increased HRV) among emergency physicians who received a simulation education intervention. Reduced physiologic stress generated by adaptive simulation interventions may improve both patient safety and clinician well-being.