1
|
Sanfilippo F, Noto A, Ajello V, Martinez Lopez de Arroyabe B, Aloisio T, Bertini P, Mondino M, Silvetti S, Putaggio A, Continella C, Ranucci M, Sangalli F, Scolletta S, Paternoster G. The Use of Pulmonary Artery Catheters and Echocardiography in the Cardiac Surgery Setting: A Nationwide Italian Survey. J Cardiothorac Vasc Anesth 2024; 38:1941-1950. [PMID: 38897888 DOI: 10.1053/j.jvca.2024.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Wide variations exist in the use of pulmonary artery catheters (PACs) and echocardiography in the field of cardiac surgery. DESIGN A national survey promoted by the Italian Association of Cardio-Thoracic Anesthesiologists and Intensive Care was conducted. SETTING The study occurred in Italian cardiac surgery centers (n = 71). PARTICIPANTS Anesthesiologists-intensivists were enrolled. INTERVENTIONS Anonymous questionnaires were used to investigate the use of PACs and echocardiography in the operating room (OR) and intensive care unit (ICU). MEASUREMENTS AND MAIN RESULTS A total of 257 respondents (32.2% response rate) from 59 centers (83.1% response rate) participated. Use of PACs seems less common in ORs (median insertion in 20% [5-70] of patients), with slightly higher use in ICUs; in about half of cases, it was the continuous cardiac output monitoring system of choice. Almost two-thirds of respondents recently inserted at least one PAC within a few hours of ICU admission, despite its need being largely preoperatively predictable. Protocols regulating PAC insertion were reported by 25.3% and 28% of respondents (OR and ICU, respectively). Transesophageal echocardiography (TEE) was performed intraoperatively in >75% of patients by 86.4% of respondents; only 23.7% stated that intraoperative TEE relied on anesthesiologists. Tissue Doppler and/or 3D imaging were widely available (87.4% and 82%, respectively), but only 37.8% and 24.3% of respondents self-declared skills in these modalities, respectively; 77.1% of respondents had no echocardiography certification, nor were pursuing certification (various reasons); 40.9% had not attended recent echocardiography courses. Lower PAC use was associated with university hospitals (OR: p = 0.014, ICU: p = 0.032) and with lower interventions/year (OR: p = 0.023). Higher independence in performing TEE was reported in university hospitals (OR: p < 0.001; ICU: p = 0.006), centers with higher interventions/year (OR: p = 0.019), and by respondents with less experience in cardiology (ICU: p = 0.046). CONCLUSION Variability in the use of PACs and echocardiography was found. Protocols regulating the use of PACs seem infrequent. University centers use PACs less and have greater skills in TEE. Training and certifications in echocardiography should be encouraged.
Collapse
Affiliation(s)
- Filippo Sanfilippo
- University Hospital Policlinico G. Rodolico-San Marco, Catania, Italy; Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
| | - Alberto Noto
- Division of Anesthesia and Intensive Care, Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi," Policlinico "G. Martino," University of Messina, Messina, Italy
| | - Valentina Ajello
- Department of Cardiac Anesthesia, Tor Vergata University Hospital, Rome, Italy
| | - Blanca Martinez Lopez de Arroyabe
- Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, Department of Emergency and Intensive Care, University Hospital of Verona, Verona, Italy
| | - Tommaso Aloisio
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit (ICU), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, Italy
| | - Pietro Bertini
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Michele Mondino
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Simona Silvetti
- Department of Cardiac Anesthesia and Intensive Care, Ospedale Policlinico San Martino IRCCS-IRCCS Cardiovascular Network, Genova, Italy
| | - Antonio Putaggio
- School of Anesthesia and Intensive Care, University Magna Graecia, Catanzaro, Italy
| | - Carlotta Continella
- School of Anesthesia and Intensive Care, University Magna Graecia, Catanzaro, Italy
| | - Marco Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit (ICU), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, Italy
| | - Fabio Sangalli
- Department of Anesthesia and Intensive Care, Azienda Socio-Sanitaria Territoriale Valtellina e Alto Lario, Sondrio, Italy
| | - Sabino Scolletta
- Department of Emergency-Urgency, University Hospital of Siena, Siena, Italy
| | - Gianluca Paternoster
- Department of Cardiovascular Anesthesia and ICU, San Carlo Hospital, Potenza, Italy
| |
Collapse
|
2
|
Borde DP, Joshi S, Srinivasa Murthy N, Murali Mohan Reddy G. Incidence and Factors Associated With Burnout Among Cardiac Anesthesiologists in India. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00507-X. [PMID: 39218768 DOI: 10.1053/j.jvca.2024.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/18/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Many previous surveys have demonstrated a high incidence of burnout among anesthesiologists. The current survey was designed to estimate the incidence and understand the factors associated with burnout among cardiac anesthesiologists in India. DESIGN Members of the Indian Association of Cardiovascular and Thoracic Anaesthesiologists (IACTA) were invited to participate. The survey consisted of two sections: the initial section collected demographic data, work patterns, and factors associated with burnout perception. The second part assessed emotional exhaustion (EE), depersonalization (DP), and low personal accomplishment (LPA) using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). SETTING Web-based survey. PARTICIPANTS Members of IACTA. INTERVENTIONS None. MEASUREMENT AND RESULTS A high score on EE (≥27 and/or DP ≥10) identified those at high risk for burnout. A high risk of burnout in addition to LPA ≤33 was defined as burnout syndrome. Of the 2,262 IACTA members surveyed, 325 (14.35%) responded. Among them, 162 (49.8%) were classified as at high risk of burnout, and 91 (28%) met the criteria for burnout syndrome. Logistic regression analysis identified factors associated with a high risk of burnout, including <5 years of experience (odds ratio [OR] = 3.53), insufficient external support (OR = 2.87), limited personal time (OR = 1.96), and considering leaving cardiac anesthesia (OR = 3.61). Factors contributing to burnout syndrome were <5 years of experience (OR = 3.83), inadequate workplace colleague support (OR = 1.84), and considering leaving cardiac anesthesia (OR = 2.43). CONCLUSIONS The burden of burnout syndrome is high among Indian anesthesiologists. Risk factors included younger age, inadequate workplace and external support, limited personal time, and contemplation of leaving cardiac anesthesia. There is a need for various stakeholders to be sensitized and institute necessary measures to reduce the burden and impact of burnout.
Collapse
Affiliation(s)
- Deepak Prakash Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India.
| | - Shreedhar Joshi
- Department of Cardiac Anesthesia, Narayana Institute of Cardiovascular Sciences Bangalore, Karnataka, India
| | | | - Gopireddy Murali Mohan Reddy
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India; Department of Cardiac Anesthesia, Narayana Institute of Cardiovascular Sciences Bangalore, Karnataka, India; Division of Evidence Synthesis, CoGuide Academy, Bangalore, Karnataka, India
| |
Collapse
|
3
|
Vanneman MW, Thuraiappah M, Feinstein I, Fielding-Singh V, Peterson A, Kronenberg S, Angst MS, Aghaeepour N. Variability and relative contribution of surgeon- and anesthesia-specific time components to total procedural time in cardiac surgery. J Thorac Cardiovasc Surg 2024; 168:559-568.e6. [PMID: 37574007 PMCID: PMC10859543 DOI: 10.1016/j.jtcvs.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 07/20/2023] [Accepted: 08/07/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Decreasing variability in time-intensive tasks during cardiac surgery may reduce total procedural time, lower costs, reduce clinician burnout, and improve patient access. The relative contribution and variability of surgeon control time (SCT) and anesthesia control time (ACT) to total procedural time is unknown. METHODS A total of 669 patients undergoing coronary artery bypass graft (CABG) surgery were enrolled. Using linear regression, we estimated adjusted SCTs and ACTs, controlling for patient and procedural covariates. The primary endpoint compared overall SCTs and ACTs. The secondary endpoint compared the variability in adjusted SCTs and ACTs. Sensitivity analyses quantified the relative importance of the specific surgeon and anesthesiologist in the adjusted linear models. RESULTS The median SCT was 4.1 hours (interquartile range [IQR], 3.4-4.9 hours) compared to a median ACT of 1.0 hours (IQR, 0.8-1.2 hours; P < .001). Using linear regression, the variability in adjusted SCT among surgeons (range, 1.8 hours) was 3.5-fold greater than the variability in adjusted ACT among anesthesiologists (range, 0.5 hour; P < .001). The specific surgeon and anesthesiologist accounted for 50% of the explanatory power of the predictive model (P < .001). CONCLUSIONS SCT variability is significantly greater than ACT variability and is strongly associated with the surgeon performing the procedure. Although these results suggest that SCT variability is an attractive operational target, further studies are needed to determine practitioner specific and modifiable attributes to reduce variability and improve efficiency.
Collapse
Affiliation(s)
- Matthew William Vanneman
- Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif.
| | - Melan Thuraiappah
- Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Igor Feinstein
- Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Vikram Fielding-Singh
- Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Ashley Peterson
- Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Scott Kronenberg
- Department of Cardiovascular Health Quality, Stanford Healthcare, Stanford, Calif
| | - Martin S Angst
- Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif
| | - Nima Aghaeepour
- Division of Cardiovascular & Thoracic Anesthesia, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, Calif; Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| |
Collapse
|
4
|
Ippolito M, Einav S, Giarratano A, Cortegiani A. Effects of fatigue on anaesthetist well-being and patient safety: a narrative review. Br J Anaesth 2024; 133:111-117. [PMID: 38641516 DOI: 10.1016/j.bja.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024] Open
Abstract
The elements that render anaesthesia a captivating profession can also foster stress and fatigue. Professionals considering anaesthesia as a career choice should have a comprehensive understanding of the negative consequences of fatigue and its implications for clinical performance and of the available preventive measures. Available evidence suggests that factors unrelated to patient characteristics or condition can affect clinical outcomes where anaesthetists are involved. Workload, nighttime work, and fatigue are persistent issues in anaesthesia and are perceived as presenting greater perioperative risks to patients. Fatigue seems to negatively affect both physical and mental health of anaesthetists. Existing evidence justifies specific interventions by institutions, stakeholders, and scientific societies to address the effects of anaesthetist fatigue. This narrative review summarises current knowledge regarding the effects of fatigue on anaesthetist well-being and patient safety, and discusses potential preventive solutions.
Collapse
Affiliation(s)
- Mariachiara Ippolito
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy; Department of Anaesthesia Intensive Care and Emergency, University Hospital Policlinico 'Paolo Giaccone', Palermo, Italy
| | - Sharon Einav
- Maccabi Healthcare Services Regional Director Hod HaSharon, Jerusalem, Israel; Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Antonino Giarratano
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy; Department of Anaesthesia Intensive Care and Emergency, University Hospital Policlinico 'Paolo Giaccone', Palermo, Italy
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy; Department of Anaesthesia Intensive Care and Emergency, University Hospital Policlinico 'Paolo Giaccone', Palermo, Italy.
| |
Collapse
|
5
|
Vittori A, Petrucci E, Cascella M, Bignami EG, Simonini A, Sollecchia G, Fiore G, Vergallo A, Marinangeli F, Pedone R. Maladaptive personality traits are associated with burnout risk in Italian anesthesiologists and intensivists: a secondary analysis from a cross-sectional study. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2024; 4:36. [PMID: 38907360 PMCID: PMC11193186 DOI: 10.1186/s44158-024-00171-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/27/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Burnout is a maladaptive response to chronic stress, particularly prevalent among clinicians. Anesthesiologists are at risk of burnout, but the role of maladaptive traits in their vulnerability to burnout remains understudied. METHODS A secondary analysis was performed on data from the Italian Association of Hospital Anesthesiologists, Pain Medicine Specialists, Critical Care, and Emergency (AAROI-EMAC) physicians. The survey included demographic data, burnout assessment using the Maslach Burnout Inventory (MBI) and subscales (emotional exhaustion, MBI-EE; depersonalization, MBI-DP; personal accomplishment, MBI-PA), and evaluation of personality disorders (PDs) based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders Fourth Edition) criteria using the assessment of DSM-IV PDs (ADP-IV). We investigated the aggregated scores of maladaptive personality traits as predictor variables of burnout. Subsequently, the components of personality traits were individually assessed. RESULTS Out of 310 respondents, 300 (96.77%) provided complete information. The maladaptive personality traits global score was associated with the MBI-EE and MBI-DP components. There was a significant negative correlation with the MBI-PA component. Significant positive correlations were found between the MBI-EE subscale and the paranoid (r = 0.42), borderline (r = 0.39), and dependent (r = 0.39) maladaptive personality traits. MBI-DP was significantly associated with the passive-aggressive (r = 0.35), borderline (r = 0.33), and avoidant (r = 0.32) traits. Moreover, MBI-PA was negatively associated with dependent (r = - 0.26) and avoidant (r = - 0.25) maladaptive personality features. CONCLUSIONS There is a significant association between different maladaptive personality traits and the risk of experiencing burnout among anesthesiologists. This underscores the importance of understanding and addressing personality traits in healthcare professionals to promote their well-being and prevent this serious emotional, mental, and physical exhaustion state.
Collapse
Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165, Rome, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, 67100, L'Aquila, Italy
| | - Marco Cascella
- Unit of Anesthesiology, Intensive Care Medicine, and Pain Medicine, Department of Anesthesia and Critical Care, Department of Medicine, Surgery, and Dentistry, University of Salerno, 84082, Baronissi (Salerno), Italy.
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, 43121, Parma, Italy
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit AOU Delle Marche, Salesi Children's Hospital, 60121, Ancona, Italy
| | - Giacomo Sollecchia
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, 67100, L'Aquila, Italy
| | - Gilberto Fiore
- Department of Anesthesia and Intensive Care, Hospital of Santa Croce Di Moncalieri, 10024, Turin, Italy
| | - Alessandro Vergallo
- Department of Anesthesia and Intensive Care, Spedali Civili Di Brescia, 25121, Brescia, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, 67100, L'Aquila, Italy
| | - Roberto Pedone
- Department of Psychology, University of Campania Luigi Vanvitelli, 8100, Caserta, Italy
| |
Collapse
|
6
|
Ippolito M, Noto A, Lakbar I, Chalkias A, Afshari A, Kranke P, Garcia CSR, Myatra SN, Schultz MJ, Giarratano A, Bilotta F, De Robertis E, Einav S, Cortegiani A. Peri-operative night-time work of anaesthesiologists: A qualitative study of critical issues and proposals. Eur J Anaesthesiol 2024; 41:34-42. [PMID: 37972930 DOI: 10.1097/eja.0000000000001930] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Qualitative data on the opinions of anaesthesiologists regarding the impact of peri-operative night-time working conditions on patient safety are lacking. OBJECTIVES This study aimed to achieve in-depth understanding of anaesthesiologists' perceptions regarding the impact of night-time working conditions on peri-operative patient safety and actions that may be undertaken to mitigate perceived risks. DESIGN Qualitative analysis of responses to two open-ended questions. SETTING Online platform questionnaire promoted by the European Society of Anaesthesiology and Intensive Care (ESAIC). PARTICIPANTS The survey sample consisted of an international cohort of anaesthesiologists. MAIN OUTCOME MEASURES We identified and classified recurrent themes in the responses to questions addressing perceptions regarding (Q1) peri-operative night-time working conditions, which may affect patient safety and (Q2) potential solutions. RESULTS We analysed 2112 and 2113 responses to Q1 and Q2, respectively. The most frequently reported themes in relation to Q1 were a perceived reduction in professional performance accompanied by concerns regarding the possible consequences of work with fatigue (27%), and poor working conditions at night-time (35%). The most frequently proposed solutions in response to Q2 were a reduction of working hours and avoidance of 24-h shifts (21%), an increase in human resources (14%) and performance of only urgent or emergency surgeries at night (14%). CONCLUSION Overall, the surveyed anaesthesiologists believe that workload-to-staff imbalance and excessive working hours were potential bases for increased peri-operative risk for their patients, partly because of fatigue-related medical errors during night-time work. The performance of nonemergency elective surgical cases at night and lack of facilities were among the reported issues and potential targets for improvement measures. Further studies should investigate whether countermeasures can improve patient safety as well as the quality of life of anaesthesia professionals. Regulations to improve homogeneity, safety, and quality of anaesthesia practice at night seem to be urgently needed.
Collapse
Affiliation(s)
- Mariachiara Ippolito
- From the Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo (MI, AG, AC), Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo (MI, AG, AC), Division of Anaesthesia and Intensive Care, Department of Human Pathology of the Adult and Evolutive Age 'Gaetano Barresi', University of Messina, Policlinico 'G. Martino', Messina, Italy (AN), Anesthesiology and Intensive Care, Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, Montpellier Cedex 5, Montpellier, France (IL), Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA (AC), Outcomes Research Consortium, Cleveland, OH, USA (AC), Department of Paediatric and Obstetric Anaesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (AA), Institute of Clinical Medicine, University of Copenhagen (AA), Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany (PK), Consorcio Hospital General Universitario de Valencia, Valencia. Methodology research Department, Universidad Europea de Valencia, Spain (CSRG), Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India (SNM), Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands (MJS), Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (MJS), Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK (MJS), Department of Anaesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I Teaching Hospital, Sapienza University of Rome, Rome (FB), Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and surgery. University of Perugia, Italy (EDR) and General Intensive Care Unit of the Shaare Zedek Medical Centre and the Hebrew University Faculty of Medicine, Jerusalem, Israel (SE)
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Nelson O, Greenwood E, Simpao AF, Matava CT. Refocusing on work-based hazards for the anaesthesiologist in a post-pandemic era. BJA OPEN 2023; 8:100234. [PMID: 37942056 PMCID: PMC10630594 DOI: 10.1016/j.bjao.2023.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/18/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023]
Abstract
The coronavirus pandemic has raised public awareness of one of the many hazards that healthcare workers face daily: exposure to harmful pathogens. The anaesthesia workplace encompasses the operating room, interventional radiology suite, and other sites that contain many other potential occupational and environmental hazards. This review article highlights the work-based hazards that anaesthesiologists and other clinicians may encounter in the anaesthesia workplace: ergonomic design, physical, chemical, fire, biological, or psychological hazards. As the anaesthesia work environment enters a post-COVID-19 pandemic phase, anaesthesiologists will do well to review and consider these hazards. The current review includes proposed solutions to some hazards and identifies opportunities for future research.
Collapse
Affiliation(s)
- Olivia Nelson
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Eric Greenwood
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Allan F. Simpao
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Clyde T. Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
8
|
Galvano AN, Ippolito M, Noto A, Lakbar I, Einav S, Giarratano A, Cortegiani A. Nighttime working as perceived by Italian anesthesiologists: a secondary analysis of an international survey. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2023; 3:32. [PMID: 37697413 PMCID: PMC10494393 DOI: 10.1186/s44158-023-00119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/02/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND No data are available on the working conditions and workload of anesthesiologists during perioperative nighttime work in Italy and on the perceived risks. RESULTS We analyzed 1085 responses out of the 5292 from the whole dataset. Most of the responders (76%) declared working a median of 12 consecutive hours during night shifts, with an irregular nightshift schedule (70%). More than half of the responders stated to receive a call 2-4 (40%) or 5 times or more (25%) to perform emergency procedures and/or ICU activities during night shifts. More than 70% of the responders declared having relaxation rooms for nighttime work (74%) but none to be used after a nightshift before going back home (82%) and no free meals, snacks, or beverages (89%). Furthermore, almost all (95%) of the surveyed anesthesiologists declared not having received specifical training or education on how to work at night, and that no institutional program has been held by the hospital to monitor fatigue or stress for night workers (99%). More than half of the responders stated having the possibility, sometimes (38%) or always (45%), to involve another colleague in difficult medical decisions and to feel comfortable, sometimes (31%) or always (35%), to call the on-call colleague. Participants declared that nighttime work affects their quality of life extremely (14%) or significantly (63%), and that sleep deprivation, fatigue, and current working conditions may reduce performance (67%) and increase risk for the patients (74%). CONCLUSIONS Italian anesthesiologists declare current nighttime practice to negatively affect their quality of life, and their performance, and are thus concerned for their patients' safety. Proper education on night work, starting from traineeship, and implementing institutional programs to monitor stress and fatigue of operators and to support them during nighttime work could be a mean to improve nighttime work conditions and safety for both patients and healthcare workers.
Collapse
Affiliation(s)
- Alberto Nicolò Galvano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Via del Vespro 129, 90127, Palermo, Italy
| | - Alberto Noto
- Division of Anesthesia and Intensive Care, Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Policlinico "G. Martino," University of Messina, Messina, Italy
| | - Inès Lakbar
- Anesthesiology and Intensive Care, Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, 80 Avenue Augustin Fliche, Montpellier Cedex 5, Montpellier, France
| | - Sharon Einav
- General Intensive Care Unit of the Shaare Zedek Medical Centre and the Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Via del Vespro 129, 90127, Palermo, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.
- Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Via del Vespro 129, 90127, Palermo, Italy.
| |
Collapse
|
9
|
Cortegiani A, Ippolito M, Lakbar I, Afshari A, Kranke P, Garcia CSR, Myatra SN, Schultz MJ, Giarratano A, Bilotta F, De Robertis E, Noto A, Einav S. The burden of peri-operative work at night as perceived by anaesthesiologists: An international survey. Eur J Anaesthesiol 2023; 40:326-333. [PMID: 36651200 DOI: 10.1097/eja.0000000000001791] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND No international data are available on the night working conditions and workload of anaesthesiologists and their opinions about associated risks. OBJECTIVE The aim of this international survey was to describe the peri-operative night working conditions of anaesthesiologists and their perception of the impact these conditions have on patient outcomes and their own quality of life. DESIGN Cross-sectional survey. SETTING Not applicable. PARTICIPANTS Anaesthesiologists providing peri-operative care during night shifts responded to an online survey promoted by the European Society of Anaesthesiology and Intensive Care (ESAIC). INTERVENTIONS None. MAIN OUTCOME MEASURE Twenty-eight closed questions. RESULTS Overall 5292 complete responses were analysed. Of these, 920 were from trainees. The median reported monthly number of night shifts was 4 [IQR 3-6]. An irregular weekly night shift schedule was most common (51%). Almost all the respondents (98%) declared that their centres have no relevant institutional programmes to monitor stress or fatigue. Most respondents (90%) had received no training or information regarding performance improvement methods for night work. Most respondents were of the opinion that sleep deprivation affects their professional performance (71%) and that their fatigue during night work may increase the peri-operative risk for their patients (74%). Furthermore, 81% of the respondents agreed or strongly agreed that night work represents an additional risk per se for patient safety, and 77% stated that their night work affects the quality of their daily life significantly or extremely. CONCLUSION Anaesthesiologists commonly perform perioperative night work without appropriate training, education or support on this specific condition. They perceive current practice as adversely affecting their professional performance and the safety of their patients. They also report significant effects on their own quality of life. Adequate training and education for night work may ally some of these concerns and programmes to monitor workers' stress and fatigue should be mandated to assess whether these concerns are justified. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Andrea Cortegiani
- From the Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo (AC, MI, AG), Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy (AC, MI, AG), Department of Anesthesiology and Intensive Care Unit, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Nord Hospital, Marseille, France (IL), Department of Paediatric and Obstetric Anaesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (AA), Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany (PK), Consorcio Hospital General Universitario de Valencia, Avenida Tres Cruces, Valencia. Methodology Research Department, Universidad Europea de Valencia, Spain (CSRG), Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India (SNM), Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', AZ, Amsterdam, the Netherlands (MJS), Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (MJS), Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK (MJS), Department of Anaesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I Teaching Hospital, Sapienza University of Rome, Rome (FB), Section of Anesthesia, Analgesia and Intensive Care, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia (EdeR), Division of Anesthesia and Intensive Care, Department of Human Pathology of the Adult and Evolutive Age 'Gaetano Barresi', University of Messina, Policlinico 'G. Martino', Messina, Italy (AN) and General Intensive Care Unit of the Shaare Zedek Medical Centre and the Hebrew University Faculty of Medicine, Jerusalem, Israel (SE)
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Provenchère S. [The operating room, at the center of the danger]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2023; 68:42-45. [PMID: 37127389 DOI: 10.1016/j.soin.2023.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Cardiac anesthesiologists face a demanding and stressful practice that requires a sense of well-being at work that is essential to patient safety and quality of care. Like all cardiac caregivers, they are exposed to the death of the people they care for and must nevertheless overcome the difficulties associated with the management of heavy patients.
Collapse
Affiliation(s)
- Sophie Provenchère
- Département d'anesthésie-réanimation, Hôpital Bichat-Claude-Bernard, 46 rue Henri-Huchard, 75877 Paris cedex 18, France; Comité anesthésie-réanimation cœur-thorax-vaisseaux, Société française d'anesthésie et de réanimation, 74 rue Raynouard, 75016 Paris, France; Société française de chirurgie thoracique et cardiovasculaire, 56 boulevard Vincent-Auriol, 75013 Paris, France.
| |
Collapse
|
11
|
Michela DT, Rachele M, Alessia R, Daniela DB, Marco R, Luigi T, Petrini F, Grazia FM. COVID-19 pandemic burnout in an Italian sample of anaesthesiologists: coping strategies, resilience and the capability of tolerating the uncertainty as preventing factors. PSYCHOL HEALTH MED 2023; 28:648-659. [PMID: 36053014 DOI: 10.1080/13548506.2022.2119484] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The present study aims to explore the prevalence of burnout characteristics and their association with resilience, coping strategies, and the intolerance of uncertainty dimensions. It also aims to explore the predictive effect of these variables on burnout dimensions, separately. Through the SurveyMonkey platform, 1,009 anaesthesiologists completed the Maslach Burnout Inventory (MBI), Resilience Scale, Intolerance of Uncertainty Scale Short Form (IU), and the Coping Inventory for Stressful Situations (CISS). According to the MBI cut-off, 39.7% and 25.8% of participants scored high in Emotional Exhaustion and Depersonalization, respectively, and 44.2% scored low in Personal Accomplishment. Several significant correlations between burnout dimensions and resilience, coping strategies, and the intolerance of uncertainty emerged. Regarding the linear regression models tested, coping strategies, resilience, and age showed a significant predictive effect on all three of the burnout dimensions. In conclusion, the results showed that individual levels of resilience and one's ability to tolerate uncertainty and task-oriented coping strategies represent significant factors for lower burnout levels in Italian anaesthesiologists during COVID-19 pandemic. These findings highlight the importance of intervention aimed at promoting useful coping strategies and enhancing resilience among healthcare workers.
Collapse
Affiliation(s)
- Di Trani Michela
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Mariani Rachele
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Renzi Alessia
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | | | - Rossi Marco
- Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care SIAARTI, Italy.,Department Emergency, Anesthesiology and Intensive Care, Catholic University of Holy Heart, Policlinico A. Gemelli IRCCS Foundation, Rome, Italy
| | - Tritapepe Luigi
- Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care SIAARTI, Italy.,U.O. of Anesthesia and Intensive Care, San Camillo-Forlanini Hospital, Rome, Italy
| | - Flavia Petrini
- Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care SIAARTI, Italy
| | - Frigo Maria Grazia
- Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care SIAARTI, Italy.,U.O. of Obstetric Anesthesia, Clinical Risk, Fatebenefratelli Hospital, Rome, Italy
| |
Collapse
|
12
|
Frigo MG, Petrini F, Tritapepe L, Rossi M, DE Berardinis D, Renzi A, Mariani R, DI Trani M. Burnout in Italian anesthesiologists and intensivists during the COVID-19 pandemic: a national survey. Minerva Anestesiol 2023; 89:188-196. [PMID: 36282228 DOI: 10.23736/s0375-9393.22.16737-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND COVID-19 pandemic added additional burden upon healthcare systems and anesthesiology and intensive care physicians (AI) who possessed crucial expertise for dealing with the pandemic. Aim of the study was to uncover specific burnout patterns among Italian AI, exploring the hypothesis that burnout has a multicluster structure. Differences in social and professional characteristics between burnout patterns were explored. METHODS One thousand and nine AI (658 women) members of the Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI) working during COVID-19 pandemic participated. Sociodemographic, working information and burnout levels evaluated through Maslach Burnout Inventory (MBI) were collected. RESULTS According to the MBI cutoff, 39.7% and 25.8% of participants scored high in emotional exhaustion and depersonalization respectively, and 44.2% scored low in personal accomplishment. Cluster analysis highlighted four burnout profiles: resilience, detachment, burnout, and emotional reserve. The results showed that AI in the Resilience and Emotional Reserve groups were significantly older and more experienced than those in the Detachment and Burnout groups. Additionally, more of the individuals in the Resilience group were working in intensive care units and departments dedicated to COVID-19 patients. The Detachment group was comprised of more AI working in operating units, while the Burnout group contained a higher number of AI working in COVID-19 departments. CONCLUSIONS These findings highlight different burnout patterns in Italian AI: older age, more professional experience, and work in intensive care units and departments dedicated to COVID-19 seemed to be protective factors during the pandemic. This appears a first step to promote focused interventions.
Collapse
Affiliation(s)
- Maria G Frigo
- Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva - SIAARTI, Rome, Italy.,Unit of Obstetric Anesthesia and Clinical Risk, Fatebenefratelli Hospital, Rome, Italy
| | - Flavia Petrini
- Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva - SIAARTI, Rome, Italy
| | - Luigi Tritapepe
- Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva - SIAARTI, Rome, Italy.,Unit of Anesthesia and Intensive Care, San Camillo-Forlanini Hospital, Rome, Italy
| | - Marco Rossi
- Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva - SIAARTI, Rome, Italy.,Department of Emergency, Anesthesiology and Intensive Care, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | | | - Alessia Renzi
- Department of Dynamic, Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Rachele Mariani
- Department of Dynamic, Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Michela DI Trani
- Department of Dynamic, Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy -
| |
Collapse
|
13
|
Vittori A, Marinangeli F, Bignami EG, Simonini A, Vergallo A, Fiore G, Petrucci E, Cascella M, Pedone R. Analysis on Burnout, Job Conditions, Alexithymia, and Other Psychological Symptoms in a Sample of Italian Anesthesiologists and Intensivists, Assessed Just before the COVID-19 Pandemic: An AAROI-EMAC Study. Healthcare (Basel) 2022; 10:healthcare10081370. [PMID: 35893193 PMCID: PMC9394278 DOI: 10.3390/healthcare10081370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 12/30/2022] Open
Abstract
Background. It was previously reported that health care professionals working in the fields of anesthesiology and emergency are at higher risk of burnout. However, the correlations between burnout, alexithymia, and other psychological symptoms are poorly investigated. Furthermore, there is a lack of evidence on which risk factors, specific to the work of anesthetists and intensivists, can increase the risk of burnout, and which are useful for developing remedial health policies. Methods. This cross-sectional study was conducted in 2020 on a sample of 300 professionals recruited from AAROI-EMAC subscribers in Italy. Data collection instruments were a questionnaire on demographic, education, job characteristics and well-being, the Maslach Burnout Inventory Tool, the Toronto Alexithymia Scale, the Symptom Checklist-90-R, and the Rosenberg Self-Esteem Scale administered during refresher courses in anesthesiology. Correlations between burnout and physical and psychological symptoms were searched. Results. With respect to burnout, 29% of individuals scored at high risk on emotional exhaustion, followed by 36% at moderate–high risk. Depersonalization high and moderate–high risk were scored by 18.7% and 34.3% of individuals, respectively. Burnout personal accomplishment was scored by 34.7% of respondents. The highest mean scores of burnout dimensions were related to dissatisfaction with one’s career, conflicting relationships with surgeons, and, finally, difficulty in explaining one’s work to patients. Conclusions. Burnout rates in Italian anesthesiologists and intensivists have been worrying since before the COVID-19 pandemic. Anesthesiologists with higher levels of alexithymia are more at risk for burnout. It is therefore necessary to take urgent health policy measures.
Collapse
Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO ROMA, Ospedale Pediatrico Bambino Gesù IRCCS, 00165 Rome, Italy
- Correspondence: ; Tel.: +39-06-68592397
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, 67100 L’Aquila, Italy;
- Simulearn, Simulation Center of AAROI-EMAC, 40121 Bologna, Italy;
| | - Elena Giovanna Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy;
| | - Alessandro Simonini
- Pediatric Anesthesia and Intensive Care Unit, Salesi Children’s Hospital, 60121 Ancona, Italy;
| | - Alessandro Vergallo
- Simulearn, Simulation Center of AAROI-EMAC, 40121 Bologna, Italy;
- Department of Anesthesia and Intensive Care, Spedali Civili di Brescia, 25121 Brescia, Italy
| | - Gilberto Fiore
- Department of Anesthesia and Intensive Care, Hospital of Santa Croce di Moncalieri, 10024 Turin, Italy;
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, 67100 L’Aquila, Italy;
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori—IRCCS, Fondazione Pascale, 80131 Naples, Italy;
| | - Roberto Pedone
- Department of Psychology, University of Campania Luigi Vanvitelli, 8100 Caserta, Italy;
| |
Collapse
|
14
|
Motta P P, Kreeger R, Resheidat AM, Faraoni D, Nasr VG, Mossad EB, Mittnacht AJ. Selected 2021 Highlights in Congenital Cardiac Anesthesia. J Cardiothorac Vasc Anesth 2022; 36:2265-2270. [DOI: 10.1053/j.jvca.2022.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/11/2022]
|
15
|
|
16
|
Burnout prevalence among European physicians: a systematic review and meta-analysis. Int Arch Occup Environ Health 2021; 95:259-273. [PMID: 34628517 DOI: 10.1007/s00420-021-01782-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/16/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Our objective was to assess burnout prevalence rates among physicians practicing in Europe (regardless of their specialty) taking into account the main approaches used to define burnout with the Maslach Burnout Inventory (MBI) tool. METHODS A systematic review was carried out from 2006 to 2018. A keyword request was obtained using the PubMed/Medline, Web of Science and Banque de Données en Santé Publique search engine. Studies written in English measuring burnout with the MBI tool among a population of practicing European physicians were selected. Data were extracted and classified according to burnout's definition provided by the authors. Three definitions using the MBI dimensions were considered: tri-, bi- and unidimensional definition. A meta-analysis was then performed on burnout prevalence rates according to the dimensional definition of burnout. RESULTS From 2378 search results, we selected 56 studies including from up to 41 European countries. Depending upon the study, physicians' burnout prevalence rates ranged from 2.5% to 72.0%. The pooled prevalence rate of burnout was estimated at 7.7% [5.3-10.4%] with the tridimensional definition, 19.7% [13.5-26.3%] with the bidimensional definition and 43.2% [29.0-57.6%] with the unidimensional definition. CONCLUSION Burnout pooled prevalence among physicians varies from single to fivefold depending on the method employed to assess burnout with the MBI tool. Medical community should determine a standardized method to assess burnout prevalence rates to best evaluate this phenomenon.
Collapse
|
17
|
Yetneberk T, Firde M, Eshetie D, Tiruneh A, Moore J. The prevalence of burnout syndrome and its association with adherence to safety and practice standards among anesthetists working in Ethiopia. Ann Med Surg (Lond) 2021; 69:102777. [PMID: 34522375 PMCID: PMC8424445 DOI: 10.1016/j.amsu.2021.102777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 08/23/2021] [Accepted: 09/02/2021] [Indexed: 11/27/2022] Open
Abstract
Background Burnout amongst healthcare professionals is a serious challenge affecting health care practice and quality of care. The ongoing pandemic has highlighted this on a global level. This study aimed to determine the prevalence of burnout syndrome and its association with adherence to safety and practice standards among non-physician anesthetists in Ethiopia. Methods A cross-sectional survey was conducted amongst non-physician anesthetists throughout Ethiopia in January 2020 utilizing an online validated questionnaire containing sociodemographic characteristics, symptoms of burnout using the 22 items of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) scale, 10 questions designed to evaluate the best practice of providers, and 7 questions evaluating self-reported errors. The MBI-HSS questions assessed depersonalization, emotional exhaustion, and personal accomplishment. A high level of burnout was defined as a respondent with an emotional exhaustion score ≥27, a depersonalization score ≥10, and a personal accomplishment score ≤33 in the MBI-HSS subscales. Bi-variable and multivariable logistic regression were used to identify factors associated with burnout. Results Out of a total of 650 anesthetists approached, 400 responded, a response rate of 61.5%. High levels of burnout were identified in 17.3% of Ethiopian anesthesia providers. Significant burnout scores were found in academic anesthetists (p = 0.01), and were associated with less years of anesthesia experience (p < 0.001), consuming >5 alcoholic drinks per week (p = 0.02), and parenthood (p = 0.01). Conclusion We found that non physician anesthetists working in Ethiopia is suffering by high levels of burnout. The problem is alarming in those working at academic environments and less experienced. Burnout were identified in 17.3% of Ethiopian anesthesia providers. Significant burnout scores were found in academic anesthetists. Anesthetists who have high burnout score committed medical malpractice.
Collapse
Affiliation(s)
- Tikuneh Yetneberk
- Department of Anesthesia and Critical Care, Debre Tabor University, Debre Tabor, Ethiopia
| | - Meseret Firde
- Department of Anesthesia and Critical Care, Debre Tabor University, Debre Tabor, Ethiopia
| | - Dinberu Eshetie
- Department of Anesthesia and Critical Care, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abebe Tiruneh
- Department of Anesthesia and Critical Care, Debre Tabor University, Debre Tabor, Ethiopia
| | - Jolene Moore
- School of Medicine Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
18
|
Sanfilippo F, Palumbo GJ, Noto A, Pennisi S, Mineri M, Vasile F, Dezio V, Busalacchi D, Murabito P, Astuto M. Prevalence of burnout among intensive care physicians: a systematic review. Rev Bras Ter Intensiva 2021; 32:458-467. [PMID: 33053037 PMCID: PMC7595726 DOI: 10.5935/0103-507x.20200076] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/25/2020] [Indexed: 12/18/2022] Open
Abstract
Objective We performed a systematic review to summarize the knowledge regarding the prevalence of burnout among intensive care unit physicians. Methods We conducted a systematic review of the MEDLINE and PubMed® databases (last update 04.02.2019) with the goal of summarizing the evidence on burnout among intensive care unit physicians. We included all studies reporting burnout in intensive care unit personnel according to the Maslach Burnout Inventory questionnaire and then screened studies for data on burnout among intensive care unit physician specifically. Results We found 31 studies describing burnout in intensive care unit staff and including different healthcare profiles. Among these, 5 studies focused on physicians only, and 12 others investigated burnout in mixed intensive care unit personnel but provided separate data on physicians. The prevalence of burnout varied greatly across studies (range 18% - 49%), but several methodological discrepancies, among them cut-off criteria for defining burnout and variability in the Likert scale, precluded a meaningful pooled analysis. Conclusion The prevalence of burnout syndrome among intensive care unit physicians is relatively high, but significant methodological heterogeneities warrant caution being used in interpreting our results. The lower reported levels of burnout seem higher than those found in studies investigating mixed intensive care unit personnel. There is an urgent need for consensus recommending a consistent use of the Maslach Burnout Inventory test to screen burnout, in order to provide precise figures on burnout in intensive care unit physicians.
Collapse
Affiliation(s)
- Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, A.O.U. "Policlinico-Vittorio Emanuele" - Catania, Itália
| | - Gaetano Joseph Palumbo
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania - Catania, Itália
| | - Alberto Noto
- Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Division of Anesthesia and Critical Care, University of Messina - Messina, Itália
| | - Salvatore Pennisi
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania - Catania, Itália
| | - Mirko Mineri
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania - Catania, Itália
| | - Francesco Vasile
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania - Catania, Itália
| | - Veronica Dezio
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania - Catania, Itália
| | - Diana Busalacchi
- School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania - Catania, Itália
| | - Paolo Murabito
- Department of Anesthesia and Intensive Care, A.O.U. "Policlinico-Vittorio Emanuele" - Catania, Itália.,School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania - Catania, Itália.,Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania - Catania, Itália
| | - Marinella Astuto
- Department of Anesthesia and Intensive Care, A.O.U. "Policlinico-Vittorio Emanuele" - Catania, Itália.,School of Anaesthesia and Intensive Care, University Hospital "G. Rodolico", University of Catania - Catania, Itália.,Department of General Surgery and Medical-Surgical Specialties, Section of Anesthesia and Intensive Care, University of Catania - Catania, Itália
| |
Collapse
|
19
|
Lasalvia A, Amaddeo F, Porru S, Carta A, Tardivo S, Bovo C, Ruggeri M, Bonetto C. Levels of burn-out among healthcare workers during the COVID-19 pandemic and their associated factors: a cross-sectional study in a tertiary hospital of a highly burdened area of north-east Italy. BMJ Open 2021; 11:e045127. [PMID: 33455940 PMCID: PMC7813385 DOI: 10.1136/bmjopen-2020-045127] [Citation(s) in RCA: 140] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To determine burn-out levels and associated factors among healthcare personnel working in a tertiary hospital of a highly burdened area of north-east Italy during the COVID-19 pandemic. DESIGN Observational study conducted from 21 April to 6 May 2020 using a web-based questionnaire. SETTING Research conducted in the Verona University Hospital (Veneto, Italy). PARTICIPANTS Out of 2195 eligible participants, 1961 healthcare workers with the full range of professional profiles (89.3%) completed the survey. PRIMARY OUTCOME MEASURE Levels of burn-out, assessed by the Maslach Burnout Inventory-General Survey (MBI-GS). Multivariable logistic regression analysis was performed to identify factors associated with burn-out in each MBI-GS dimension (emotional exhaustion, EX; professional efficacy, EF; cynicism, CY). RESULTS Overall, 38.3% displayed high EX, 46.5% low EF and 26.5% high CY. Burn-out was frequent among staff working in intensive care units (EX 57.0%; EF 47.8%; CY 40.1%), and among residents (EX 34.9%; EF 63.9%; CY 33.4%) and nurses (EX 49.2%; EF 46.9%; CY 29.7%). Being a resident increased the risk of burn-out (by nearly 2.5 times) in all the three MBI subscales and being a nurse increased the risk of burn-out in the EX dimension in comparison to physicians. Healthcare staff directly engaged with patients with COVID-19 showed more EX and CY than those working in non-COVID wards. Finally, the risk of burn-out was higher in staff showing pre-existing psychological problems, in those having experienced a COVID-related traumatic event and in those having experienced interpersonal avoidance in the workplace and personal life. CONCLUSIONS Burn-out represents a great concern for healthcare staff working in a large tertiary hospital during the COVID-19 pandemic and its impact is more burdensome for front-line junior physicians. This study underlines the need to carefully address psychological well-being of healthcare workers to prevent the increase of burn-out in the event of a new COVID-19 healthcare emergency.
Collapse
Affiliation(s)
- Antonio Lasalvia
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Amaddeo
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- UOC Psicosomatica e Psicologia Medica, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Stefano Porru
- Section of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona and Clinical Unit of Occupational Medicine, Integrated University Hospital of Verona, Verona, Italy
| | - Angela Carta
- Section of Occupational Medicine, Department of Diagnostics and Public Health, University of Verona and Clinical Unit of Occupational Medicine, Integrated University Hospital of Verona, Verona, Italy
| | - Stefano Tardivo
- Section of Hygiene, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Chiara Bovo
- Health Director, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
| | - Mirella Ruggeri
- UOC Psichiatria, Azienda Ospedaliera Universitaria Integrata (AOUI) di Verona, Verona, Italy
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Bonetto
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| |
Collapse
|
20
|
Kalboussi H, Chouchane A, Ferhi F, Nsiri L, Maoua M, El Guedri S, Aroui H, Kacem I, Brahem A, Chatti S, El Maalel O, Ben Jazia K, Mrizak N. Facteurs associés au burn-out chez les techniciens supérieurs d’anesthésie réanimation dans un centre hospitalo-universitaire au centre tunisien. ANNALES MEDICO-PSYCHOLOGIQUES 2020. [DOI: 10.1016/j.amp.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
21
|
Di Monte C, Monaco S, Mariani R, Di Trani M. From Resilience to Burnout: Psychological Features of Italian General Practitioners During COVID-19 Emergency. Front Psychol 2020; 11:567201. [PMID: 33132972 PMCID: PMC7566043 DOI: 10.3389/fpsyg.2020.567201] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/28/2020] [Indexed: 11/13/2022] Open
Abstract
During the COronaVIrus Disease 2019 (COVID-19) pandemic in Italy, general practitioners (GPs) are ensuring continued access to primary care for citizens while also absorbing more of the impact of the crisis than most professional groups. The aim of this study is to explore the relationships between dimensions of burnout and various psychological features among Italian GPs during the COVID-19 emergency. A group of 102 GPs completed self-administered questionnaires available online through Google Forms, including Maslach Burnout Inventory (MBI), Resilience Scale, Intolerance of Uncertainty Scale Short Form (IU), and Coping Inventory for Stressful Situations (CISS). Cluster analysis highlighted four distinct burnout risk profiles: Low Burnout, Medium Risk, High Risk, and High Burnout. The High Burnout group showed both lower Resilience and lower CISS Task-oriented coping strategy than the Medium Risk group and higher IU Prospective than the Low Burnout group. Results of a linear regression analysis confirmed that CISS Emotion-oriented style positively predicted MBI Emotional Exhaustion, CISS Task-oriented and Emotion-oriented emerged as significant predictors (negatively and positively, respectively) of MBI Depersonalization, and Resilience positively predicted MBI Personal Accomplishment. In conclusion, the results showed that the COVID-19 emergency had a significant impact on GPs’ work management. Implementing task-oriented problem management, rather than emotional strategies, appears to protect against burnout in these circumstances. It is possible that the emotions related to the pandemic are too intense to be regulated and used productively to manage the professional issues that the COVID-19 pandemic presents.
Collapse
Affiliation(s)
- Cinzia Di Monte
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Silvia Monaco
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Rachele Mariani
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Michela Di Trani
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
22
|
Vargas M, Spinelli G, Buonanno P, Iacovazzo C, Servillo G, De Simone S. Burnout Among Anesthesiologists and Intensive Care Physicians: Results From an Italian National Survey. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 57:46958020919263. [PMID: 32713227 PMCID: PMC7383656 DOI: 10.1177/0046958020919263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Burnout is one of the main chronic health problems with negative consequences on caregivers but also on the quality of care. This is a multidimensional occupational syndrome, characterized by three main criteria: emotional exhaustion (EE), depersonalization (DP), and low personal accomplishment (PA). Burnout is particularly identified in professionals working in caregiving and human services, especially the ones who are interpersonally stressed and emotionally vulnerable. Intensive care professionals seem to face a critical risk of burnout. This study aiming to evaluate the occurrence and the risk factors of burnout among Italian anesthesiologists and intensive care physicians. All members included in the mailing list of the Italian Society of Anesthesia, Analgesia, and Intensive Care were invited to participate in an online survey. An anonymous questionnaire was distributed via a specific website. Burnout was measured using the Maslach Burnout Inventory (MBI) questionnaire. All responses were evaluated through univariate and multivariable logistic regression. A total of 859 physicians out of 3,654 (23.5%) participated in this online survey. According to the MBI criteria for a high degree of burnout, 10.2% (88) of the respondents reported high EE, high DP, and low PA together; 79.9% (686) exhibited a moderate degree of burnout; and 9.9% (85) reported a low degree of burnout, with normal values in all three of the explored psychological dimensions. This study reported mostly a moderate level of burnout among Italian anesthesiologist and intensive care physicians since we found 10.2% incidence for high degree of burnout according to the MBI criteria.
Collapse
Affiliation(s)
- Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Gianmario Spinelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Carmine Iacovazzo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Stefania De Simone
- Institute for Research on Innovation and Services for Development, National Research Council of Italy, Naples, Italy
| |
Collapse
|
23
|
Neelankavil J, Goeddel LA, Dwarakanath S, Methangkool E, Feinman JW, Harvey R, Hatton K, Kostibas MP, Shah R, Ho J, Patel PA, Howard-Quijano J, Nyhan D, Augoustides JG. Mentoring Fellows in Adult Cardiothoracic Anesthesiology for Academic Practice in the Contemporary Era—Perspectives From Mentors Around the United States. J Cardiothorac Vasc Anesth 2020; 34:521-529. [DOI: 10.1053/j.jvca.2019.01.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Indexed: 12/14/2022]
|
24
|
Repeated Cross-sectional Surveys of Burnout, Distress, and Depression among Anesthesiology Residents and First-year Graduates. Anesthesiology 2019; 131:668-677. [DOI: 10.1097/aln.0000000000002777] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Abstract
Editor’s Perspective
What We Already Know about This Topic
What This Article Tells Us That Is New
Background
This repeated cross-sectional survey study was conducted to determine the prevalence of, and factors associated with, burnout, distress, and depression among anesthesiology residents and first-year graduates. We hypothesized that heavy workload and student debt burden were associated with a higher risk of physician burnout, distress, and depression, and that perception of having adequate workplace resources, work–life balance, and social support were associated with a lower risk.
Methods
Physicians beginning U.S. anesthesiology residency between 2013 and 2016 were invited to take online surveys annually from their clinical anesthesia year 1 to 1 yr after residency graduation. The Maslach Burnout Inventory, the Physician Well-Being Index, and the Harvard Department of Psychiatry/National Depression Screening Day Scale were used to measure burnout, distress, and depression, respectively. Logistic regression analyses were conducted to examine whether self-reported demographics, personal, and professional factors were associated with the risk of burnout, distress, and depression.
Results
The response rate was 36% (5,295 of 14,529). The prevalence of burnout, distress, and depression was 51% (2,531 of 4,966), 32% (1,575 of 4,941), and 12% (565 of 4,840), respectively. Factors associated with a lower risk of all three outcomes included respondents’ perceived workplace resource availability, (odds ratio = 0.51 [95% CI, 0.45 to 0.57] for burnout; 0.51 [95% CI, 0.45 to 0.56] for distress; 0.52 [95% CI, 0.45 to 0.60] for depression) and perceived ability to maintain work–life balance (0.61 [95% CI, 0.56 to 0.67] for burnout; 0.50 [95% CI, 0.46 to 0.55] for distress; 0.58 [95% CI, 0.51 to 0.65] for depression). A greater number of hours worked per week and a higher amount of student debt were associated with a higher risk of distress and depression, but not burnout.
Conclusions
Burnout, distress, and depression are notable among anesthesiology residents. Perceived institutional support, work–life balance, strength of social support, workload, and student debt impact physician well-being.
Collapse
|
25
|
Brakke T, Thompson A, Shillcutt SK, Augoustides JG. Burnout in Cardiothoracic Anesthesiology-Expert Perspectives in the Contemporary Era. J Cardiothorac Vasc Anesth 2019; 33:1766-1770. [PMID: 30704827 DOI: 10.1053/j.jvca.2019.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Tara Brakke
- Department of Anesthesiology, University of Nebraska, Omaha, NE
| | - Annemarie Thompson
- Divisions of Cardiothoracic Anesthesia and Critical Care, Department of Anesthesiology, Duke University, Durham, NC
| | | | - John G Augoustides
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| |
Collapse
|
26
|
De Hert S. Burnout Among Anesthesiologists: It׳s Time for Action! J Cardiothorac Vasc Anesth 2018; 32:2467-2468. [DOI: 10.1053/j.jvca.2018.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Indexed: 11/11/2022]
|