Department of Emergency Medicine, Indiana University School of Medicine, 1701 N. Senate Blvd, Indianapolis, IN, 46202, USA.
Indiana University School of Medicine, Indianapolis, IN, USA.
BMC Emerg Med. 2021 Mar 24;21(1):36. doi: 10.1186/s12873-021-00425-3.
While COVID-19 has had far-reaching consequences on society and health care providers, there is a paucity of research exploring frontline emergency medicine (EM) provider wellness over the course of a pandemic. The objective of this study was to assess the well-being, resilience, burnout, and wellness factors and needs of EM physicians and advanced practice providers (e.g., nurse practitioners and physician assistants; APPs) during the initial phase of the COVID-19 pandemic.
A descriptive, prospective, cohort survey study of EM physicians and APPs was performed across ten emergency departments in a single state, including academic and community settings. Participants were recruited via email to complete four weekly, voluntary, anonymous questionnaires comprised of customized and validated tools for assessing wellness (Well Being Index), burnout (Physician Work Life Study item), and resilience (Brief Resilience Scale) during the initial acceleration phase of COVID-19. Univariate and multivariate analysis with Chi-squared, Fisher's Exact, and logistic regression was performed.
Of 213 eligible participants, response rates ranged from 31 to 53% over four weeks. Women comprised 54 to 60% of responses. Nonrespondent characteristics were similar to respondents. Concern for personal safety decreased from 85 to 61% (p < 0.001). Impact on basic self-care declined from 66 to 32% (p < 0.001). Symptoms of stress, anxiety, or fear was initially 83% and reduced to 66% (p = 0.009). Reported strain on relationships and feelings of isolation affected > 50% of respondents initially without significant change (p = 0.05 and p = 0.30 respectively). Women were nearly twice as likely to report feelings of isolation as men (OR 1.95; 95% CI 1.82-5.88). Working part-time carried twice the risk of burnout (OR, 2.45; 95% CI, 1.10-5.47). Baseline resilience was normal to high. Provider well-being improved over the four weeks (30 to 14%; p = 0.01), but burnout did not significantly change (30 to 22%; p = 0.39).
This survey of frontline EM providers, including physicians and APPs, during the initial surge of COVID-19 found that despite being a resilient group, the majority experienced stress, anxiety, fear, and concerns about personal safety due to COVID-19, putting many at risk for burnout. The sustained impact of the pandemic on EM provider wellness deserves further investigation to guide targeted interventions.
尽管 COVID-19 对社会和医疗保健提供者产生了深远的影响，但目前缺乏对大流行期间一线急诊医学（EM）提供者健康状况的研究。本研究的目的是评估 COVID-19 大流行初期 EM 医师和高级实践提供者（例如，护士从业者和医师助理；APPs）的幸福感、韧性、倦怠和健康因素以及需求。
对一个州的十个急诊部的 EM 医师和 APP 进行了描述性、前瞻性、队列调查研究，包括学术和社区环境。通过电子邮件向参与者招募，要求他们在 COVID-19 最初加速阶段完成四份每周自愿匿名问卷，这些问卷使用定制和验证的工具评估幸福感（幸福感指数）、倦怠（医师工作生活研究项目）和韧性（简短韧性量表）。使用卡方检验、Fisher 精确检验和逻辑回归进行单变量和多变量分析。
在 213 名符合条件的参与者中，四周内的回复率在 31%至 53%之间。女性占回应的 54%至 60%。未回复者的特征与回复者相似。对个人安全的担忧从 85%下降到 61%（p<0.001）。对基本自我保健的影响从 66%下降到 32%（p<0.001）。最初有 83%的人出现压力、焦虑或恐惧的症状，后来减少到 66%（p=0.009）。超过 50%的受访者最初报告说，人际关系紧张和孤立感对他们有影响，但没有明显变化（p=0.05 和 p=0.30）。与男性相比，女性感到孤立的可能性几乎是男性的两倍（OR 1.95；95%CI 1.82-5.88）。兼职工作的倦怠风险是全职工作的两倍（OR，2.45；95%CI，1.10-5.47）。基线韧性正常到高。在四周内，提供者的幸福感有所提高（30%至 14%；p=0.01），但倦怠没有明显变化（30%至 22%；p=0.39）。
本项针对 COVID-19 初期一线 EM 提供者（包括医师和 APP）的调查发现，尽管这是一个有韧性的群体，但由于 COVID-19，大多数人经历了压力、焦虑、恐惧和对个人安全的担忧，这使许多人面临倦怠的风险。大流行对 EM 提供者健康状况的持续影响值得进一步调查，以指导有针对性的干预措施。
