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: 9886646
• 负责人: Bernard P. Chang
• 金额: $ 81万
• 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/9886646
• 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; burnout; cardiovascular disorder risk; cardiovascular risk factor; cohort; design; exhaustion; follow-up; heart disease risk; improved; innovation; 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.

10 年前，医学研究所宣布急诊科 (ED) 过度拥挤为“危机”， 此后，急诊室变得更加拥挤。在拥挤的急诊室接受治疗的患者面临更高的风险。 随后的心血管疾病（CVD）和精神疾病，很大程度上是由于患者的增加 急诊科住院期间的心理压力，以及 ED 压力源与患者 CVD 和 CVD 的关联。 心理结果已确定，但很少有工作探讨 ED 环境因素对 ED 的影响 护士和医生常年处于压力大且经常人满为患的急诊室——通常是在病情不佳之后 这项研究将测试可改变的 ED 因素和/或睡眠不足是否会增加。 ED 中的动态血压 (ABP) 和心理风险 美国 100 万医生中有 45% 报告有职业倦怠症状，这一比例高达 ED 的 70% 提供者报告倦怠症状（即情绪疲惫、人格解体和个人能力下降） 有证据表明急性护理的各个方面（拥挤、急性和慢性压力、转移）。 工作）可能会导致倦怠风险，这与较差的患者护理和更多的医疗错误有关，并且 倦怠也是 CVD 的一个独立危险因素，与冠心病风险增加 37% 有关。 疾病（CHD）事件，与年龄、体重指数、吸烟和血脂水平无关。 倦怠与心血管疾病相关的机制包括自主神经失调和血液增加 同样，最近的荟萃分析显示睡眠时间短（<6 小时）与发生冠心病有关。 风险（RR=1.26），可能是通过类似的途径造成的，这是轮班工作的另一个后果。 常见于急诊科，也会增加 CVD 风险。 我们将测试 ED 因素、睡眠和昼夜节律失调对 ABP（CVD 的主要标志物）的影响 风险）和倦怠的创新研究设计，利用我们在 ED 研究、行为心脏病学、 我们将前瞻性地跟踪一组急诊室医生和护士 3 年，检验这一假设。 急诊科工作因素（例如急诊科过度拥挤、睡眠不足以及轮班工作导致的昼夜节律失调）， 增加倦怠并有助于增加 ABP。我们将不断采集有关患者数量的 ED 数据， 每年，参与者将完成为期两周的突发测试，监测睡眠持续时间和昼夜节律。 在每次爆发期间，我们将评估倦怠、工作压力和 24 小时 ABP。 该设计将使我们能够：1）评估急诊室拥挤、昼夜节律失调的短期影响， 睡眠时间短与 ABP 的急剧变化和心理风险 2) 表征了累积的关系 ED 压力暴露和睡眠障碍对 CVD 3 年进展和心理风险的影响。