Burnout

BurnoutThe Critical Care Societies Collaborative (CCSC) has published a report on burnout syndrome that gives critical care healthcare professionals guidance on mitigating the development of burnout syndrome and calls for initiating research to examine ways to prevent as well as treat burnout syndrome.

The complete statement can be viewed in the official publication of each CCSC member journal: American Association of Critical-Care Nurses (AACN), the American College of Chest Physicians (CHEST), the American Thoracic Society (ATS), and Society of Critical Care Medicine (SCCM).

Join the conversation at #StopICUBurnout.

Burnout Syndrome Defined:
Burnout syndrome is a state of emotional, mental and physical exhaustion caused by excessive and prolonged stress. This exhaustion is typically work-related and is triggered by discrepancies between the expectations and the actual requirements of the job. Burnout syndrome has become a common worldwide phenomenon, especially among members of high-stress professions, such as firefighters, police officers, teachers and all types of health-care professionals.

Critical care health care professionals have one of the highest rates of burnout syndrome, with nearly half of the workforce exhibiting symptoms.

The co-published document reports:
• Up to 45 percent of critical care physicians reported symptoms of severe burnout syndrome, while those specializing in pediatric critical care were at 71 percent.
• Approximately 25 to 33 percent of critical care nurses manifest symptoms of severe burnout syndrome, and up to 86 percent have at least one of the three classic symptoms.
• The high burnout syndrome rate in critical care professionals can be attributed to the especially stressful environment in the ICU due to high patient morbidity and mortality, challenging daily work routines, and regular encounters with traumatic and ethical issues.
• Burnout syndrome in critical care health care professionals may result in posttraumatic stress disorder, alcohol abuse and even suicidal thoughts.
• In nurses, burnout is associated with reduced quality of care, lower patient satisfaction, increased number of medical errors, higher rates of health care associated infections, and higher 30-day patient mortality rates.

Exploring Solutions and Research:

“Everyone has a part to play in decreasing burnout syndrome. A full collaborative effort is required among researchers, educators, professional societies, patient advocacy groups, funding agencies, policy makers and ourselves as critical care health care professionals” says Dr. Marc Moss, co-author, vice chair of Clinical Research for the Department of Medicine at the University of Colorado School of Medicine, and president-elect of the American Thoracic Society. “We can’t take care of patients if we don’t take care of each other. An increased commitment to research on burnout syndrome is a necessary first step.”

The CCSC call to action advises key stakeholder groups to help mitigate the development of burnout syndrome. Key stakeholders include critical care clinicians, friends and family, ICU unit-based leaders, hospital administrators, funding agencies, professional societies, academic institutions, patient advocacy groups and policy makers. Two potential strategies for dealing with burnout include interventions focused on enhancing the ICU environment and helping individuals cope with their environment.

The CCSC is looking into ways to combat burnout syndrome in the ICU, including analyzing current research on related topics. A study from the journal Academic Medicine noted that the use of mindfulness training in health care professionals has demonstrated beneficial effects including improved attentiveness and responsiveness to patients’ concerns and development of adaptive reserve. A 2011 report in Nursing Standard identified problem-focused coping style, self-awareness, and lifestyle and coping strategies as ways to mitigate burnout syndrome. In 2013, ESSAI reported that self-care and stress reduction measures can build resilience to help address and even prevent burnout syndrome.

“With more than 10,000 critical care physicians and 500,000 critical care nurses practicing in the United States, the effects of burnout syndrome in the ICU cannot be ignored,” says Dr. Curt Sessler, senior author and immediate past president of the American College of Chest Physicians. “We believe that protecting the mental and physical health of health care professionals who are at risk for burnout syndrome is vitally important for not only the professionals but for all stakeholders, including our patients.”

Next Steps:

The Critical Care Societies Collaborative, is planning a “National Summit on Prevention and Management of Burnout in the ICU”, to be held December 2017, in Chicago, Illinois. The Summit is being proposed in response to a national “Call to Action” that was published in July, 2016 to address burnout syndrome (BOS) in ICU healthcare professionals.

The purpose of the Summit is to: 1) identify steps in implementing the call to action to focus on prevention and treatment of burnout in ICU healthcare professionals; 2) outline the preferred treatments related to individual and organizational factors influencing burnout; 3) describe key approaches for disseminating interventions and addressing barriers; and 4) define gaps in the field to outline a research agenda.

The one day meeting would include brief morning presentations, followed by breakout panel-led discussions organized by theme, including 1) key approaches for prevention 2) individual focused interventions to address BOS 3) organizational interventions to address BOS and 3) identification of gaps in knowledge. Each breakout group will also be tasked to identify priority areas for research. Theme breakout sessions will include focused questions and discussions, followed by consensus building and forming practice, education, and research recommendations. Information discussed, recommendations, and action items from each theme will be reported out at the end of the day.

The Summit would have representation from the fields of Medicine, Psychology, Sociology, Occupational Health, Nursing and Allied Health experts; professionals trained in meditation, time management, mindfulness, yoga, tai chi and other behavioral and stress reduction measures; as well as educators, researchers, healthcare administrators and students. The Summit will also emphasize person and family centered care by including former ICU patients and current ICU providers.

Resources:

  • Awa, W. L., Plaumann, M., & Walter, U. (2010). Burnout prevention: A review of intervention programs. Patient Education and Counseling, 78(2), 184-190. doi:10.1016/j.pec.2009.04.008
  • Goitein, L., O’Malley, P. G., & Redberg, R. F. (2016). Physician Work Environment and Well-being: A Call for Papers. JAMA Internal Medicine, 177(2), 164-165. doi:10.1057/9780230363038.0006
  • Linzer, M., Levine, R., Meltzer, D., Poplau, S., Warde, C., & West, C. P. (2013). 10 Bold Steps to Prevent Burnout in General Internal Medicine. Journal of General Internal Medicine, 29(1), 18-20. doi:10.1007/s11606-013-2597-8
  • Panagioti, M., Panagopoulou, E., Bower, P., Lewith, G., Kontopantelis, E., Chew-Graham, C., . . . Esmail, A. (2017). Controlled Interventions to Reduce Burnout in Physicians. JAMA Internal Medicine, 177(2), 195. doi:10.1001/jamainternmed.2016.7674
  • Shanafelt, T. D., & Noseworthy, J. H. (2017). Executive Leadership and Physician Well-being. Mayo Clinic Proceedings, 92(1), 129-146. doi:10.1016/j.mayocp.2016.10.004
  • West, C. P., Dyrbye, L. N., Erwin, P. J., & Shanafelt, T. D. (2016). Interventions to prevent and reduce physician burnout: a systematic review and meta-analysis. The Lancet, 388(10057), 2272-2281. doi:10.1016/s0140-6736(16)31279-x