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Ahya VN, De Luca D. Rebuttal From Drs Ahya and De Luca. Chest 2024; 165:1044-1045. [PMID: 38724145 DOI: 10.1016/j.chest.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Vivek N Ahya
- Clinical Practices of the University of Pennsylvania, Pulmonary, Allergy & Critical Care Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "A.Béclère" Medical Center, Paris-Saclay University Hospitals and the Physiopathology and Therapeutic Innovation Unit, Paris-Saclay University, Paris, France
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An Official Critical Care Societies Collaborative Statement: Burnout Syndrome in Critical Care Healthcare Professionals: A Call for Action. Crit Care Med 2017; 44:1414-21. [PMID: 27309157 DOI: 10.1097/ccm.0000000000001885] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Burnout syndrome (BOS) occurs in all types of healthcare professionals and is especially common in individuals who care for critically ill patients. The development of BOS is related to an imbalance of personal characteristics of the employee and work-related issues or other organizational factors. BOS is associated with many deleterious consequences, including increased rates of job turnover, reduced patient satisfaction, and decreased quality of care. BOS also directly affects the mental health and physical well-being of the many critical care physicians, nurses, and other healthcare professionals who practice worldwide. Until recently, BOS and other psychological disorders in critical care healthcare professionals remained relatively unrecognized. To raise awareness of BOS, the Critical Care Societies Collaborative (CCSC) developed this call to action. The present article reviews the diagnostic criteria, prevalence, causative factors, and consequences of BOS. It also discusses potential interventions that may be used to prevent and treat BOS. Finally, we urge multiple stakeholders to help mitigate the development of BOS in critical care healthcare professionals and diminish the harmful consequences of BOS, both for critical care healthcare professionals and for patients.
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Martins Pereira S, Teixeira CM, Carvalho AS, Hernández-Marrero P. Compared to Palliative Care, Working in Intensive Care More than Doubles the Chances of Burnout: Results from a Nationwide Comparative Study. PLoS One 2016; 11:e0162340. [PMID: 27612293 PMCID: PMC5017676 DOI: 10.1371/journal.pone.0162340] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/22/2016] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Professionals working in intensive and palliative care units, hence caring for patients at the end-of-life, are at risk of developing burnout. Workplace conditions are determinant factors to develop this syndrome among professionals providing end-of-life care. OBJECTIVES To identify and compare burnout levels between professionals working in intensive and palliative care units; and to assess which workplace experiences are associated with burnout. METHODS A nationwide, multicentre quantitative comparative survey study was conducted in Portugal using the following instruments: Maslach Burnout Inventory-Human Services Survey, Questionnaire of workplace experiences and ethical decisions, and Questionnaire of socio-demographic and professional characteristics. A total of 355 professionals from 10 intensive care and 9 palliative care units participated in the survey. A series of univariate and multivariate logistic regression analyses were performed; odds ratio sidelong with 95% confidence intervals were calculated. RESULTS 27% of the professionals exhibited burnout. This was more frequent in intensive care units (OR = 2.525, 95% CI: 1.025-6.221, p = .006). Univariate regression analyses showed that higher burnout levels were significantly associated with conflicts, decisions to withhold/withdraw treatment, and implementing palliative sedation. When controlling for socio-demographic and educational characteristics, and setting (intensive care units versus palliative care units), higher burnout levels were significantly and positively associated with experiencing conflicts in the workplace. Having post-graduate education in intensive/palliative care was significantly but inversely associated to higher burnout levels. CONCLUSIONS Compared to palliative care, working in intensive care units more than doubled the likelihood of exhibiting burnout. Experiencing conflicts (e.g., with patients and/or families, intra and/or inter-teams) was the most significant determinant of burnout and having post-graduate education in intensive/palliative care protected professionals from developing this syndrome. This highlights the need for promoting empowering workplace conditions, such as team empowerment and conflict management. Moreover, findings suggest the need for implementing quality improvement strategies and organizational redesign strategies aimed at integrating the philosophy, principles and practices of palliative care in intensive care units.
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Affiliation(s)
| | - Carla Margarida Teixeira
- Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal
- Hospital de Santo António, Centro Hospitalar do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Dr. Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Ana Sofia Carvalho
- Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal
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Sur MD, Angelos P. Ethical Issues in Surgical Critical Care: The Complexity of Interpersonal Relationships in the Surgical Intensive Care Unit. J Intensive Care Med 2015; 31:442-50. [PMID: 25990272 DOI: 10.1177/0885066615585953] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/13/2015] [Indexed: 11/16/2022]
Abstract
A major challenge in the era of shared medical decision making is the navigation of complex relationships between the physicians, patients, and surrogates who guide treatment plans for critically ill patients. This review of ethical issues in adult surgical critical care explores factors influencing interactions among the characters most prominently involved in health care decisions in the surgical intensive care unit: the patient, the surrogate, the surgeon, and the intensivist. Ethical tensions in the surgeon-patient relationship in the elective setting may arise from the preoperative surgical covenant and the development of surgical complications. Unlike that of the surgeon, the intensivist's relationship with the individual patient must be balanced with the need to serve other acutely ill patients. Due to their unique perspectives, surgeons and intensivists may disagree about decisions to pursue life-sustaining therapies for critically ill postoperative patients. Finally, although surrogates are asked to make decisions for patients on the basis of the substituted judgment or best interest standards, these models may underestimate the nuances of postoperative surrogate decision making. Strategies to minimize conflicts regarding treatment decisions are centered on early, honest, and consistent communication between all parties.
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Affiliation(s)
- Malini D Sur
- Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
| | - Peter Angelos
- Department of Surgery, The University of Chicago Medicine, Chicago, IL, USA MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA Bucksbaum Institute for Clinical Excellence, The University of Chicago Medicine, Chicago, IL, USA
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Gabler NB, Ratcliffe SJ, Wagner J, Asch DA, Rubenfeld GD, Angus DC, Halpern SD. Mortality among patients admitted to strained intensive care units. Am J Respir Crit Care Med 2013; 188:800-6. [PMID: 23992449 DOI: 10.1164/rccm.201304-0622oc] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
RATIONALE The aging population may strain intensive care unit (ICU) capacity and adversely affect patient outcomes. Existing fluctuations in demand for ICU care offer an opportunity to explore such relationships. OBJECTIVES To determine whether transient increases in ICU strain influence patient mortality, and to identify characteristics of ICUs that are resilient to surges in capacity strain. METHODS Retrospective cohort study of 264,401 patients admitted to 155 U.S. ICUs from 2001 to 2008. We used logistic regression to examine relationships of measures of ICU strain (census, average acuity, and proportion of new admissions) near the time of ICU admission with mortality. MEASUREMENTS AND MAIN RESULTS A total of 36,465 (14%) patients died in the hospital. ICU census on the day of a patient's admission was associated with increased mortality (odds ratio [OR], 1.02 per standardized unit increase; 95% confidence interval [CI]: 1.00, 1.03). This effect was greater among ICUs employing closed (OR, 1.07; 95% CI: 1.02, 1.12) versus open (OR, 1.01; 95% CI: 0.99, 1.03) physician staffing models (interaction P value = 0.02). The relationship between census and mortality was stronger when the census was composed of higher acuity patients (interaction P value < 0.01). Averaging strain over the first 3 days of patients' ICU stays yielded similar results except that the proportion of new admissions was now also associated with mortality (OR, 1.04 for each 10% increase; 95% CI: 1.02, 1.06). CONCLUSIONS Several sources of ICU strain are associated with small but potentially important increases in patient mortality, particularly in ICUs employing closed staffing models. Although closed ICUs may promote favorable outcomes under static conditions, they are susceptible to being overwhelmed by patient influxes.
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Ju MJ, Tu GW, Han Y, He HY, He YZ, Mao HL, Wu ZG, Yin YQ, Luo JF, Zhu DM, Luo Z, Xue ZG. Effect of admission time on mortality in an intensive care unit in Mainland China: a propensity score matching analysis. Crit Care 2013; 17:R230. [PMID: 24112558 PMCID: PMC4055975 DOI: 10.1186/cc13053] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 08/15/2013] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The relationship between admission time and intensive care unit (ICU) mortality is inconclusive and influenced by various factors. This study aims to estimate the effect of admission time on ICU outcomes in a tertiary teaching hospital in China by propensity score matching (PSM) and stratified analysis. METHODS A total of 2,891 consecutive patients were enrolled in this study from 1 January 2009 to 29 December 2011. Multivariate logistic regression and survival analysis were performed in this retrospective study. PSM and stratified analysis were applied for confounding factors, such as Acute Physiology and Chronic Health Evaluation II (APACHE II) score and admission types. RESULTS Compared with office hour subgroup (n = 2,716), nighttime (NT, n = 175) subgroup had higher APACHE II scores (14 vs. 8, P < 0.001), prolonged length of stay in the ICU (42 vs. 24 h, P = 0.011), and higher percentages of medical (8.6% vs. 3.3%, P < 0.001) and emergency (59.4% vs. 12.2%, P < 0.001) patients. Moreover, NT admissions were related to higher ICU mortality [odds ratio (OR), 1.725 (95% CI 1.118-2.744), P = 0.01] and elevated mortality risk at 28 days [14.3% vs. 3.2%; OR, 1.920 (95% CI 1.171-3.150), P = 0.01]. PSM showed that admission time remained related to ICU outcome (P = 0.045) and mortality risk at 28 days [OR, 2.187 (95% CI 1.119-4.271), P = 0.022]. However, no mortality difference was found between weekend and workday admissions (P = 0.849), even if weekend admissions were more related to higher APACHE II scores compared with workday admissions. CONCLUSIONS NT admission was associated with poor ICU outcomes. This finding may be related to shortage of onsite intensivists and qualified residents during NT. The current staffing model and training system should be improved in the future.
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Affiliation(s)
- Min-Jie Ju
- Department of Anesthesiology and Surgical Intensive Critical Unit, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, People’s Republic of China
| | - Guo-Wei Tu
- Department of Anesthesiology and Surgical Intensive Critical Unit, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, People’s Republic of China
| | - Yan Han
- Department of General Medical Practice, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, People’s Republic of China
| | - Hong-Yu He
- Department of Anesthesiology and Surgical Intensive Critical Unit, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, People’s Republic of China
| | - Yi-Zhou He
- Department of Anesthesiology and Surgical Intensive Critical Unit, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, People’s Republic of China
| | - Hai-Lei Mao
- Department of Anesthesiology and Surgical Intensive Critical Unit, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, People’s Republic of China
| | - Zhao-Guang Wu
- Department of General Surgery, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032 People’s Republic of China
| | - Yi-Qing Yin
- Computer and Network Center, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, People’s Republic of China
| | - Jian-Feng Luo
- Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, People’s Republic of China
| | - Du-Ming Zhu
- Department of Anesthesiology and Surgical Intensive Critical Unit, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, People’s Republic of China
| | - Zhe Luo
- Department of Anesthesiology and Surgical Intensive Critical Unit, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, People’s Republic of China
| | - Zhang-Gang Xue
- Department of Anesthesiology and Surgical Intensive Critical Unit, Zhongshan Hospital, Fudan University, 136 Yi Xue Yuan Road, Shanghai 200032, People’s Republic of China
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