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: 10547767
• 负责人: Bernard P. Chang
• 金额: $ 76.75万
• 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/10547767
• 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; Diné Nation; 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.

10年前，美国医学研究所（Institute of Medicine）就宣布急诊科人满为患是一种“危机”，