感知工作需求和急诊部门拥挤程度预测急诊医师的客观压力：班次水平方法。
Perceived Work Demands and Emergency Department Crowding as Predictors of Objective Stress Among Emergency Physicians: A Shift-Level Approach.
机构信息
From 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.).
出版信息
J Occup Environ Med. 2024 Aug 1;66(8):654-658. doi: 10.1097/JOM.0000000000003126. Epub 2024 Apr 25.
OBJECTIVE
To understand shift-level determinants of emergency physician (EP) burnout, relationships were tested between EP shift demands, stress, and fatigue.
METHOD
EP ( n = 16) were assessed over 114 shifts that occurred before and during the COVID-19 pandemic. Salivary cortisol (an indicator of stress) and self-reported fatigue were collected prior to and following each shift. An objective crowding score (National Emergency Department Overcrowding Scale) per shift was calculated. Shift demands were assessed at the end of each shift.
RESULTS
Multilevel models revealed that shift demands, National Emergency Department Overcrowding Scale, and the pandemic were related to higher levels of end-of-shift cortisol, but not fatigue. Cortisol levels were higher for shifts with a higher number of demands, greater crowding, and during the pandemic.
CONCLUSIONS
Shift demands predicted objective indicators of stress, but not self-reported fatigue. Interventions are needed to decrease stress and shift demands to reduce EP burnout.
目的
了解导致急诊医师（EP） burnout 的轮班水平决定因素，检验 EP 轮班需求、压力和疲劳之间的关系。
方法
在 COVID-19 大流行之前和期间，对 16 名 EP 进行了 114 次轮班评估。在每次轮班前和轮班后收集唾液皮质醇（压力的一个指标）和自我报告的疲劳情况。为每次轮班计算了一个客观的拥挤评分（国家急诊部门过度拥挤量表）。在每次轮班结束时评估轮班需求。
结果
多层次模型显示，轮班需求、国家急诊部门过度拥挤量表和大流行与更高水平的轮班结束时皮质醇有关，但与疲劳无关。需求更高、拥挤程度更大的轮班和大流行期间的皮质醇水平更高。
结论
轮班需求预测了客观的压力指标，但不能预测自我报告的疲劳。需要采取干预措施来降低压力和轮班需求，以减少 EP burnout。
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