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

急诊科（艾德）过度拥挤10年前被医学研究所宣布为"危机"， 急诊室也越来越拥挤了在过度拥挤的急诊室接受治疗的患者， 随后的心血管疾病（CVD）和精神疾病，主要是由于患者的 在他们的急性护理停留期间的心理压力。虽然艾德应激源与患者CVD和 心理结果的建立，很少有工作探讨了艾德环境因素对 护士和医生多年暴露在压力和经常过度拥挤的急诊室，通常是在贫穷之后， 由于轮班工作而睡觉。这项研究将测试是否可改变的艾德因素和/或短睡眠增加 艾德临床医师的动态血压与心理风险 在美国，100万名医生中有45%报告有倦怠症状，而艾德的70%则令人惊讶。 提供者报告倦怠症状（即，情绪衰竭，人格解体，以及减少个人 成就）。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、轮班 工作）可能会导致倦怠风险，这与更糟糕的病人护理和更多的医疗错误有关， 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，与年龄、体重指数、吸烟和血脂水平无关。拟定生理学 心血管疾病与倦怠相关的机制包括自主神经失调和血液循环增加。 压力同样，最近的荟萃分析显示，睡眠不足（<6小时）与冠心病事件有关 风险（RR = 1.26），可能通过类似的途径。昼夜节律失调，轮班工作的另一个后果 常见于艾德提供者，也会增加CVD风险。 我们将测试艾德因素、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，利用我们在艾德研究，行为心脏病学， 睡觉我们将前瞻性地随访一组艾德医生和护士3年，检验这一假设 艾德工作因素（例如，艾德过度拥挤、睡眠不足和轮班工作导致的昼夜节律失调）， 增加疲劳并有助于增加ABP。我们将持续采集患者容量的艾德数据， 敏锐度和人员配备每年，参与者将完成一个为期2周的突发，监测睡眠时间，昼夜节律 失调和工作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）评估艾德拥挤，昼夜节律失调， 和短睡眠对ABP和心理危险性的急性变化的关系2）特征的累积 艾德应激暴露和睡眠障碍与3年心血管疾病进展和心理风险的关系。

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.