The Identification of Modifiable Emergency Department and Sleep Factors Contributing to Psychological and Cardiovascular Risk in Clinicians

确定导致临床医生心理和心血管风险的可修改急诊室和睡眠因素

• 批准号: 10319929
• 负责人: Bernard P. Chang
• 金额: $ 78.2万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10319929
• 关键词: Accident and Emergency department; Acute; Address; Age; Blood Pressure; Body mass index; Cardiovascular Diseases; Chronic stress; Circadian desynchrony; Coronary heart disease; Crowding; Data; Depersonalization; Disease Outcome; Emergency Department Physician; Emergency department crowding; Emotional; Environment; Environmental Risk Factor; Event; Exposure to; Health; Hour; Institute of Medicine (U.S.); Intervention; Link; Lipids; Mediating; Medical; Medical Errors; Mental disorders; Meta-Analysis; Nurses; Occupations; Participant; Pathway interactions; Patient Care; Patient risk; Patient-Focused Outcomes; Patients; Physicians; Physiological; Polysomnography; Post-Traumatic Stress Disorders; Provider; Psychological Stress; Psychosocial Factor; Reporting; Research; Research Design; Restaurants; Risk; Risk Factors; Role; Sleep; Sleep disturbances; Smoking; Societies; Stress; Symptoms; System; Testing; Work; Workplace; acute care; acute stress; behavioral cardiology; blood pressure elevation; burnout; cardiovascular disorder risk; cardiovascular risk factor; cohort; design; exhaustion; follow-up; heart disease risk; improved; innovation; poor sleep; prospective; psychologic; psychological outcomes; safety net; shift work; stressor

Emergency department (ED) overcrowding was declared a “crisis” by the Institute of Medicine 10 years ago, and EDs have become more crowded since. Patients treated in overcrowded EDs are at increased risk for subsequent cardiovascular disease (CVD) and psychiatric disorder, largely due to increases in patients’ psychological stress during their acute care stay. While the association of ED stressors with patient CVD and psychological outcomes is established, little work has explored the impact of ED environmental factors on the nurses and doctors who spend years exposed to stressful and frequently overcrowded EDs—often after poor sleep due to shift-work. This study will test whether modifiable ED factors and/or short sleep increase ambulatory blood pressure (ABP) and psychological risk in ED clinicians Whereas 45% of the 1 million physicians in the U.S. report symptoms of burnout, an astonishing 70% of ED providers report burnout symptoms (i.e., emotional exhaustion, depersonalization, and reduced personal accomplishment). There is evidence that aspects of acute care work (crowding, acute and chronic stress, shift work) may contribute to burnout risk, which is related to worse patient care and more medical errors, and is also an independent risk factor for CVD. Burnout is associated with 37% increased risk for coronary heart disease (CHD) events, independent of age, body mass index, smoking, and lipid levels. Proposed physiological mechanisms for the association of burnout with CVD include autonomic dysregulation and increased blood pressure. Similarly, recent meta-analyses have shown short sleep (<6 hours) is associated with incident CHD risk (RR=1.26), likely through similar pathways. Circadian misalignment, another consequence of shift work common in ED providers, also increases CVD risk. We will test the influence of ED factors, sleep, and circadian misalignment on ABP (a primary marker of CVD risk) and burnout in an innovative study design, leveraging our expertise in ED research, behavioral cardiology, and sleep. We will prospectively follow a cohort of ED physicians and nurses for 3 years, testing the hypothesis that ED work factors (e.g. ED overcrowding, short sleep, and circadian misalignment due to shift work), increase burnout and contribute to increased ABP. We will continually capture ED data on patient volume, acuity, and staffing. Annually, participants will complete a 2-week burst, monitoring sleep duration, circadian misalignment, and work-related stress. During each burst, we will assess burnout, job strain, and 24-hour ABP. This design will allow us to: 1) evaluate the short-term contribution of ED crowding, circadian misalignment, and short sleep to acute changes in ABP and psychological risk 2) characterize the relationship of cumulative ED stress exposures and sleep impairment to 3-year progression of CVD and psychological risk.

急诊科（ED）人满为患，被医学研究所宣布为10年前的“危机” 从那以后，ED变得更加拥挤。在人满为患的ED中治疗的患者的风险增加 随后的心血管疾病（CVD）和精神疾病，主要是由于患者的增加 急性护理期间的心理压力。而ED应激源与患者CVD的关联和 建立了心理结果，很少的工作探讨了ED环境因素对 花费多年的护士和医生承受压力且经常拥挤的ED，通常是在贫穷之后 由于轮班工作而入睡。这项研究将测试可修改的ED因素和/或短睡眠增加 ED临床医生的卧床血压（ABP）和心理风险 而美国的100万医生中有45％报告出现倦怠的症状，而ED的70％ 提供者报告倦怠症状（即情绪疲惫，人格化和个人减少 有证据表明急性护理工作的各个方面（拥挤，急性和慢性压力，转变 工作）可能会导致倦怠风险，这与患者护理较差和更多的医疗错误有关，并且是 也是CVD的独立危险因素。倦怠与冠心病风险增加37％有关 疾病（CHD）事件，独立于年龄，体重指数，吸烟和脂质水平。提出的生理学 倦怠与CVD关联的机制包括自主性失调和血液增加 压力。同样，最近的荟萃分析显示出短暂的睡眠（<6小时）与事件冠心病有关 风险（RR = 1.26），可能通过类似的途径。昼夜节律错位，转变工作的另一个结果 在ED提供商中常见，也会增加CVD风险。 我们将测试ED因素，睡眠和昼夜节律对ABP的影响（CVD的主要标记 风险）和倦怠在创新的研究设计中，利用我们的ED研究专业知识，行为心脏病学， 和睡觉。我们可能会遵循一组ED医师和护士队列3年，检验假设 ED的工作因素（例如，由于转移工作而导致的人满为患，睡眠短和昼夜节律）， 增加倦怠并增加ABP。我们将不断捕获有关患者体积的ED数据， 敏锐度和人员配备。每年，参与者将完成2周的爆发，监视睡眠时间，昼夜节律 错位和与工作有关的压力。在每次爆发期间，我们将评估倦怠，工作压力和24小时ABP。 这种设计将使我们能够：1）评估ED拥挤，昼夜节律未对准的短期贡献， 和短睡眠到ABP的急性变化和心理风险2）表征累积关系的关系 ED应力暴露和睡眠障碍对CVD和心理风险的3年进展。