1
|
Lu DW, Weygandt PL, Pinchbeck C, Strout TD. Emergency Medicine Trainee Burnout Is Associated With Lower Patients' Satisfaction With Their Emergency Department Care. AEM Educ Train 2018; 2:86-90. [PMID: 30051074 PMCID: PMC6001511 DOI: 10.1002/aet2.10094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/12/2018] [Accepted: 02/20/2018] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Emergency medicine (EM) physicians and trainees report high levels of burnout. Burnout negatively impacts physician well-being and career satisfaction but it remains unclear how burnout may influence patient care. We examined the degree to which EM trainee burnout at one institution was associated with patients' satisfaction with their emergency department (ED) care. METHODS In this cross-sectional, pilot study conducted at a single institution, we measured EM trainee burnout using the Maslach Burnout Inventory through a confidential, electronic survey. We subsequently linked individual trainee burnout results with their individual Press Ganey (PG) ED patient satisfaction scores. We compared burnout scores across sex and postgraduate year using chi-square tests and PG results via analysis of variance. RESULTS Twenty-seven of 53 (50.9%) eligible EM trainees completed the burnout assessment. Trainees reported an overall burnout rate of 77.8% (95% confidence interval = 59.2%-89.4%). There were no significant differences in burnout based on sex (p = 0.888) or postgraduate year (p = 0.671). Trainee burnout was significantly associated with lower trainee-specific PG scores, including patient ratings of resident physician courtesy (p = 0.011), taking the time to listen (p = 0.004), keeping informed of treatment (p = 0.014), and concern for patient comfort (p = 0.006). There was no significant association between trainee burnout and patients' overall likelihood to recommend the ED to others (p = 0.364). CONCLUSION Emergency medicine trainee burnout is associated with lower trainee-specific PG ED patient satisfaction scores across all four physician domains. In addition to its detrimental impact on physician wellness, burnout may play a significant adverse role in patients' perceptions of their ED providers' interpersonal and communication skills.
Collapse
Affiliation(s)
- Dave W. Lu
- Department of Emergency MedicineTufts University School of MedicineMaine Medical CenterPortlandME
| | - Paul Logan Weygandt
- Department of Emergency MedicineNorthwestern University Feinberg School of MedicineChicagoIL
- Present address:
Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Carrie Pinchbeck
- Department of Emergency MedicineNorthwestern University Feinberg School of MedicineChicagoIL
- Present address:
Department of Emergency MedicineSanta Clara Medical CenterKaiser Permanente, Santa ClaraCA
| | - Tania D. Strout
- Department of Emergency MedicineTufts University School of MedicineMaine Medical CenterPortlandME
| |
Collapse
|
2
|
Meltzer AC, Pinchbeck C, Burnett S, Buhumaid R, Shah P, Ding R, Fleischer DE, Gralnek IM. Emergency physicians accurately interpret video capsule endoscopy findings in suspected upper gastrointestinal hemorrhage: a video survey. Acad Emerg Med 2013; 20:711-5. [PMID: 23859585 DOI: 10.1111/acem.12165] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 02/19/2013] [Accepted: 02/20/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Acute upper gastrointestinal (GI) hemorrhage is a common emergency department (ED) presentation whose severity ranges from benign to life-threatening and the best tool to risk stratify the disease is an upper endoscopy, either by scope or by capsule, a procedure performed almost exclusively by gastroenterologists. Unfortunately, on-call gastroenterology specialists are often unavailable, and emergency physicians (EPs) currently lack an alternative method to endoscopically visualize a suspected acute upper GI hemorrhage. Recent reports have shown that video capsule endoscopy is well tolerated by ED patients and has similar sensitivity and specificity to endoscopy for upper GI hemorrhage. OBJECTIVES The study objective was to determine if EPs can detect upper GI bleeding on capsule endoscopy after a brief training session. METHODS A survey study was designed to demonstrate video examples of capsule endoscopy to EPs and determine if they could detect upper GI bleeding after a brief training session. All videos were generated from a prior ED-based study on patients with suspected acute upper GI hemorrhage. The training session consisted of less than 10 minutes of background information and capsule endoscopy video examples. EPs were recruited at the American College of Emergency Physicians Scientific Assembly in Denver, Colorado, from October 8, 2012, to October 10, 2012. Inclusion criteria included being an ED resident or attending physician and the exclusion criteria included any formal endoscopy training. The authors analyzed the agreement between the EPs and expert adjudicated capsule endoscopy readings for each capsule endoscopy video. For the outcome categories of blood (fresh or coffee grounds type) or no blood detected, the sensitivity and specificity were calculated. RESULTS A total of 126 EPs were enrolled. Compared to expert gastroenterology-adjudicated interpretation, the sensitivity to detect blood was 0.94 (95% confidence interval [CI] = 0.91 to 0.96) and specificity was 0.87 (95% CI = 0.80 to 0.92). CONCLUSIONS After brief training, EPs can accurately interpret video capsule endoscopy findings of presence of gross blood or no blood with high sensitivity and specificity.
Collapse
Affiliation(s)
| | | | - Sarah Burnett
- George Washington University School of Medicine; Washington; DC
| | - Rasha Buhumaid
- Emergency Medicine; George Washington University; Washington; DC
| | - Payal Shah
- Emergency Medicine; George Washington University; Washington; DC
| | - Ru Ding
- Emergency Medicine; George Washington University; Washington; DC
| | | | - Ian M. Gralnek
- Rappaport Faculty of Medicine; Technion-Israel Institute of Technology and the GI Outcomes Unit; Department of Gastroenterology; Rambam Health Care Campus; Haifa; Israel
| |
Collapse
|
3
|
Meltzer AC, Burnett S, Pinchbeck C, Brown AL, Choudhri T, Yadav K, Fleischer DE, Pines JM. Pre-Endoscopic Rockall and Blatchford Scores to Identify Which Emergency Department Patients with Suspected Gastrointestinal Bleed Do Not Need Endoscopic Hemostasis. J Emerg Med 2013; 44:1083-7. [DOI: 10.1016/j.jemermed.2012.11.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 06/27/2012] [Accepted: 11/05/2012] [Indexed: 11/30/2022]
|
4
|
Roberts MD, Drinkard B, Ranzenhofer LM, Salaita CG, Sebring NG, Brady SM, Pinchbeck C, Hoehl J, Yanoff LB, Savastano DM, Han JC, Yanovski JA. Prediction of maximal oxygen uptake by bioelectrical impedance analysis in overweight adolescents. J Sports Med Phys Fitness 2009; 49:240-5. [PMID: 19861930 PMCID: PMC3027125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIM Maximal oxygen uptake (VO(2max)), the gold standard for measurement of cardiorespiratory fitness, is frequently difficult to assess in overweight individuals due to physical limitations. Reactance and resistance measures obtained from bioelectrical impedance analysis (BIA) have been suggested as easily obtainable predictors of cardiorespiratory fitness, but the accuracy with which ht(2)/Z can predict VO(2max) has not previously been examined in overweight adolescents. METHODS The impedance index was used as a predictor of VO(2max) in 87 overweight girls and 47 overweight boys ages 12 to 17 with mean BMI of 38.6 + or - 7.3 and 42.5 + or - 8.2 in girls and boys respectively. The Bland Altman procedure assessed agreement between predicted and actual VO(2max). RESULTS Predicted VO(2max) was significantly correlated with measured VO(2max) (r(2)=0.48, P<0.0001). Using the Bland Altman procedure, there was significant magnitude bias (r(2)=0.10; P<0.002). The limits of agreement for predicted relative to actual VO(2max) were -589 to 574 mL O(2)/min. CONCLUSIONS The impedance index was highly correlated with VO(2max) in overweight adolescents. However, using BIA data to predict maximal oxygen uptake over-predicted VO(2max) at low levels of oxygen consumption and under-predicted VO(2max) at high levels of oxygen consumption. This magnitude bias, along with the large limits of agreement of BIA-derived predicted VO(2max), limit its usefulness in the clinical setting for overweight adolescents.
Collapse
Affiliation(s)
- Mary D. Roberts
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, Hatfield Clinical Research Center, National Institutes of Health, DHHS, Bethesda, MD
| | - Bart Drinkard
- Rehabilitation Medicine Department, Clinical Research Center, Hatfield Clinical Research Center, National Institutes of Health, DHHS, Bethesda, MD
| | - Lisa M. Ranzenhofer
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, Hatfield Clinical Research Center, National Institutes of Health, DHHS, Bethesda, MD
| | - Christine G. Salaita
- Nutrition Department, Hatfield Clinical Research Center, National Institutes of Health, DHHS, Bethesda, MD
| | - Nancy G. Sebring
- Nutrition Department, Hatfield Clinical Research Center, National Institutes of Health, DHHS, Bethesda, MD
| | - Sheila M. Brady
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, Hatfield Clinical Research Center, National Institutes of Health, DHHS, Bethesda, MD
| | - Carrie Pinchbeck
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, Hatfield Clinical Research Center, National Institutes of Health, DHHS, Bethesda, MD
| | - Julie Hoehl
- Rehabilitation Medicine Department, Clinical Research Center, Hatfield Clinical Research Center, National Institutes of Health, DHHS, Bethesda, MD
| | - Lisa B. Yanoff
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, Hatfield Clinical Research Center, National Institutes of Health, DHHS, Bethesda, MD
| | - David M. Savastano
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, Hatfield Clinical Research Center, National Institutes of Health, DHHS, Bethesda, MD
| | - Joan C. Han
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, Hatfield Clinical Research Center, National Institutes of Health, DHHS, Bethesda, MD
| | - Jack A. Yanovski
- Unit on Growth and Obesity, Developmental Endocrinology Branch, NICHD, Hatfield Clinical Research Center, National Institutes of Health, DHHS, Bethesda, MD
| |
Collapse
|