Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK.
BMJ Open. 2020 Nov 2;10(11):e041485. doi: 10.1136/bmjopen-2020-041485.
To determine the need for recovery (NFR) among emergency physicians and to identify demographic and occupational characteristics associated with higher NFR scores.
Cross-sectional electronic survey.
Emergency departments (EDs) (n=112) in the UK and Ireland.
Emergency physicians, defined as any registered physician working principally within the ED, responding between June and July 2019.
NFR Scale, an 11-item self-administered questionnaire that assesses how work demands affect intershift recovery.
The median NFR Score for all 4247 eligible, consented participants with a valid NFR Score was 70.0 (95% CI: 65.5 to 74.5), with an IQR of 45.5-90.0. A linear regression model indicated statistically significant associations between gender, health conditions, type of ED, clinical grade, access to annual and study leave, and time spent working out-of-hours. Groups including male physicians, consultants, general practitioners (GPs) within the ED, those working in paediatric EDs and those with no long-term health condition or disability had a lower NFR Score. After adjusting for these characteristics, the NFR Score increased by 3.7 (95% CI: 0.3 to 7.1) and 6.43 (95% CI: 2.0 to 10.8) for those with difficulty accessing annual and study leave, respectively. Increased percentage of out-of-hours work increased NFR Score almost linearly: 26%-50% out-of-hours work=5.7 (95% CI: 3.1 to 8.4); 51%-75% out-of-hours work=10.3 (95% CI: 7.6 to 13.0); 76%-100% out-of-hours work=14.5 (95% CI: 11.0 to 17.9).
Higher NFR scores were observed among emergency physicians than reported in any other profession or population to date. While out-of-hours working is unavoidable, the linear relationship observed suggests that any reduction may result in NFR improvement. Evidence-based strategies to improve well-being such as proportional out-of-hours working and improved access to annual and study leave should be carefully considered and implemented where feasible.
确定急诊医生的恢复需求（NFR），并确定与较高 NFR 评分相关的人口统计学和职业特征。
横断面电子调查。
英国和爱尔兰的急诊部（ED）（n=112）。
急诊医师，定义为主要在 ED 工作的任何注册医师，于 2019 年 6 月至 7 月期间做出回应。
NFR 量表，这是一种 11 项自我管理问卷，用于评估工作需求如何影响班次间的恢复。
所有 4247 名合格、同意并具有有效 NFR 评分的参与者的中位 NFR 评分为 70.0（95%CI：65.5 至 74.5），IQR 为 45.5-90.0。线性回归模型表明，性别、健康状况、ED 类型、临床级别、是否有年度和学习休假、以及工作时间等因素与 NFR 评分之间存在统计学显著关联。包括男性医生、顾问、ED 内的全科医生（GP）、在儿科 ED 工作的医生以及没有长期健康状况或残疾的医生在内的群体的 NFR 评分较低。在调整了这些特征后，分别难以获得年度和学习休假的医生的 NFR 评分增加了 3.7（95%CI：0.3 至 7.1）和 6.43（95%CI：2.0 至 10.8）。加班时间的增加几乎呈线性增加 NFR 评分：26%-50%加班时间=5.7（95%CI：3.1 至 8.4）；51%-75%加班时间=10.3（95%CI：7.6 至 13.0）；76%-100%加班时间=14.5（95%CI：11.0 至 17.9）。
与迄今为止报告的任何其他职业或人群相比，急诊医生的 NFR 评分更高。虽然加班是不可避免的，但观察到的线性关系表明，任何减少都可能导致 NFR 改善。应仔细考虑并在可行的情况下实施基于证据的改善幸福感的策略，例如按比例安排加班时间和增加获得年度和学习休假的机会。
