Weigl Matthias, Lifschitz Michael, Dodt Christoph
Institute for Patient Safety, University Hospital Bonn, Bonn, Germany.
Institute and Clinic for Occupational, Social and Environmental Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
Eur J Emerg Med. 2025 Feb 1;32(1):29-37. doi: 10.1097/MEJ.0000000000001159. Epub 2024 Jul 19.
Modern emergency medicine (EM) is a complex, demanding, and occasionally stressful field of work. Working conditions, provider well-being, and associated health and performance outcomes are key factors influencing the establishment of a sustainable emergency department (ED) working environment.
This multinational European Delphi survey aimed to identify unequivocal major factors for good and poor ED working conditions and their possible effects on health care provider well-being.
DESIGN/SETTING AND PARTICIPANTS: A total of 18 experts from six European countries (Belgium, Finland, Germany, Italy, Romania, and the UK) covering three different hospital sizes (small, medium, and large) in their respective countries participated in the two-round Delphi survey. All panelists held leadership roles in EM.
The first step involved conducting an extensive literature search on ED working conditions. The second step involved the first Delphi round, which consisted of structured interviews with the panelists. The survey was designed to obtain information concerning important working conditions, comments regarding work-life factors identified from the literature, and ratings of their importance. Interviews were transcribed and analyzed following a standardized protocol. In the second Delphi round, experts rated the relevance of items consolidated from the first Delphi round (classified into ED work system factors, provider health outcomes, and ED work-life intervention approaches).
A nearly unequivocal consensus was obtained in four ED work condition categories, including positive (e.g. job challenges, personal motivation, and case complexities) and negative (e.g. overcrowding, workflow interruptions/multitasking, medical errors) ED work conditions. The highly relevant adverse personal health events identified included physical fatigue, exhaustion, and burnout. Concerning intervention practices, the panelists offered a wide spectrum of opportunities with less consensus.
Work system conditions exert positive and negative effects on the work life of ED providers across Europe. Although most European countries have varying health care systems, the expert-based survey results presented herein strongly suggest that improvement strategies should focus on system-related external stressors common in various countries. Our findings lay the scientific groundwork for future intervention studies at the local and systemic levels to improve ED provider work life.
现代急诊医学（EM）是一个复杂、要求高且偶尔会有压力的工作领域。工作条件、医护人员的福祉以及相关的健康和工作表现结果是影响建立可持续急诊科（ED）工作环境的关键因素。
这项欧洲多国德尔菲调查旨在确定明确的影响急诊科工作条件好坏的主要因素及其对医护人员福祉可能产生的影响。
设计/设置与参与者：来自六个欧洲国家（比利时、芬兰、德国、意大利、罗马尼亚和英国）的18位专家参与了两轮德尔菲调查，他们分别代表各自国家三种不同规模的医院（小型、中型和大型）。所有小组成员在急诊医学领域担任领导职务。
第一步涉及对急诊科工作条件进行广泛的文献检索。第二步是第一轮德尔菲调查，包括对小组成员进行结构化访谈。该调查旨在获取有关重要工作条件的信息、从文献中确定的工作与生活因素的评论以及对其重要性的评级。访谈按照标准化方案进行转录和分析。在第二轮德尔菲调查中，专家们对第一轮德尔菲调查汇总的项目（分为急诊科工作系统因素、医护人员健康结果和急诊科工作与生活干预方法）的相关性进行了评级。
在四个急诊科工作条件类别中达成了几乎明确的共识，包括积极的（如工作挑战、个人动力和病例复杂性）和消极的（如过度拥挤、工作流程中断/多任务处理、医疗差错）急诊科工作条件。确定的高度相关的不良个人健康事件包括身体疲劳、疲惫和职业倦怠。关于干预措施，小组成员提出了广泛的机会，但共识较少。
工作系统条件对欧洲各地急诊科医护人员的工作生活产生积极和消极影响。尽管大多数欧洲国家有不同的医疗保健系统，但本文基于专家的调查结果强烈表明，改进策略应侧重于各国常见的与系统相关的外部压力源。我们的研究结果为未来在地方和系统层面进行干预研究以改善急诊科医护人员的工作生活奠定了科学基础。
