Lu Dave W, Dresden Scott, McCloskey Colin, Branzetti Jeremy, Gisondi Michael A
Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois.
University of Washington School of Medicine, Department of Emergency Medicine, Seattle, Washington.
West J Emerg Med. 2015 Dec;16(7):996-1001. doi: 10.5811/westjem.2015.9.27945. Epub 2015 Dec 11.
Burnout is a syndrome of depersonalization, emotional exhaustion and sense of low personal accomplishment. Emergency physicians (EPs) experience the highest levels of burnout among all physicians. Burnout is associated with greater rates of self-reported suboptimal care among surgeons and internists. The association between burnout and suboptimal care among EPs is unknown. The objective of the study was to evaluate burnout rates among attending and resident EPs and examine their relationship with self-reported patient care practices.
In this cross-sectional study burnout was measured at two university-based emergency medicine residency programs with the Maslach Burnout Inventory. We also measured depression, quality of life (QOL) and career satisfaction using validated questionnaires. Six items assessed suboptimal care and the frequency with which they were performed.
We included 77 out of 155 (49.7%) responses. The EP burnout rate was 57.1%, with no difference between attending and resident physicians. Residents were more likely to screen positive for depression (47.8% vs 18.5%, p=0.012) and report lower QOL scores (6.7 vs 7.4 out of 10, p=0.036) than attendings. Attendings and residents reported similar rates of career satisfaction (85.2% vs 87.0%, p=0.744). Burnout was associated with a positive screen for depression (38.6% vs 12.1%, p=0.011) and lower career satisfaction (77.3% vs 97.0%, p=0.02). EPs with high burnout were significantly more likely to report performing all six acts of suboptimal care.
A majority of EPs demonstrated high burnout. EP burnout was significantly associated with higher frequencies of self-reported suboptimal care. Future efforts to determine if provider burnout is associated with negative changes in actual patient care are necessary.
职业倦怠是一种去个性化、情感耗竭和个人成就感低落的综合征。急诊医生在所有医生中职业倦怠水平最高。职业倦怠与外科医生和内科医生自我报告的次优医疗发生率较高有关。急诊医生的职业倦怠与次优医疗之间的关联尚不清楚。本研究的目的是评估主治急诊医生和住院医师的职业倦怠率，并检查其与自我报告的患者护理行为的关系。
在这项横断面研究中，使用马氏职业倦怠量表在两个大学附属医院的急诊医学住院医师培训项目中测量职业倦怠。我们还使用经过验证的问卷测量抑郁、生活质量（QOL）和职业满意度。六项内容评估了次优医疗及其实施频率。
我们纳入了155份回复中的77份（49.7%）。急诊医生的职业倦怠率为57.1%，主治医生和住院医师之间无差异。住院医师比主治医生更有可能抑郁筛查呈阳性（47.8%对18.5%，p=0.012），并报告较低的生活质量得分（10分制中分别为6.7分和7.4分，p=0.036）。主治医生和住院医师报告的职业满意度相似（85.2%对87.0%，p=0.744）。职业倦怠与抑郁筛查呈阳性（38.6%对12.1%，p=0.011）和较低的职业满意度（77.3%对97.0%，p=0.02）相关。职业倦怠程度高的急诊医生显著更有可能报告实施了所有六项次优医疗行为。
大多数急诊医生表现出高度的职业倦怠。急诊医生的职业倦怠与自我报告的次优医疗频率显著相关。未来有必要努力确定医疗服务提供者的职业倦怠是否与实际患者护理的负面变化有关。
