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

10年前，急诊科(ED)人满为患被医学研究所宣布为“危机”。 自那以后，急诊室变得更加拥挤。在过度拥挤的急诊室接受治疗的患者患上 随后的心血管疾病(CVD)和精神障碍，主要是由于患者的 在他们的急性护理期间的心理压力。而ED应激源与患者心脑血管疾病及 心理结果是确定的，很少有工作探索ED环境因素对 多年暴露在压力大且经常人满为患的急诊室的护士和医生--通常是在贫穷之后 由于轮班工作而睡觉。这项研究将测试可改变的勃起功能障碍因素和/或短睡眠增加 ED临床医生的动态血压与心理风险 在美国的100万名医生中，45%的人报告有职业倦怠的症状，而在ED中，这一比例高达惊人的70% 医疗服务提供者报告职业倦怠症状(即情绪衰竭、人格解体和人格减退 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、轮换 工作)可能会导致职业倦怠风险，这与更差的病人护理和更多的医疗差错有关，而且 也是心血管疾病的独立危险因素。职业倦怠与冠心病风险增加37%相关 疾病(CHD)事件，与年龄、体重指数、吸烟和血脂水平无关。建议的生理学 职业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 压力。同样，最近的荟萃分析显示，短时睡眠(6小时)与冠心病相关。 风险(RR=1.26)，可能通过类似的途径。昼夜节律失调，倒班工作的另一个后果 在ED提供者中很常见，也会增加心血管疾病的风险。 我们将测试ED因素、睡眠和昼夜节律失调对ABP(心血管疾病的主要标志)的影响 风险)和倦怠，利用我们在ED研究、行为心脏病学、 然后睡觉。我们将对一组急诊医生和护士进行为期3年的前瞻性跟踪调查，以检验假设。 ED工作因素(例如，ED过度拥挤、睡眠不足和由于轮班工作而导致的昼夜节律失调)， 增加职业倦怠，并导致ABP增加。我们将持续捕获急诊室患者数量的数据， 敏锐度和人员配备。每年，参与者将完成为期两周的突击检查，监测睡眠持续时间、昼夜节律 错位和工作压力。在每一次突发事件中，我们将评估职业倦怠、工作压力和24小时ABP。 这一设计将允许我们：1)评估ED拥挤、昼夜节律失调、 睡眠不足与ABP的急性变化和心理风险2)表征了累积的关系 ED压力暴露和睡眠损害与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.