ICU Burnout at 45%, Medical Societies Call for Action

Marcia Frellick

July 07, 2016

A new report issued jointly by four critical care organizations says up to 45% of the nation's 10,000 critical care physicians and nearly a third (25% - 33%) of the 500,000 critical care nurses are reporting severe burnout.

For physicians who specialize in pediatric critical care, that proportion was 71%, which is twice the rate of that for general pediatricians. In addition, nearly 86% of critical care nurses reported at least one of the three classic symptoms of burnout syndrome (BOS): exhaustion, depersonalization (a distant or indifferent attitude toward work), and feelings of diminished personal accomplishment.

The syndrome, measured by the 22-item Maslach Burnout Inventory, is highest among those on the front lines, according to the report.

The Critical Care Societies Collaborative, which includes the American Association of Critical-Care Nurses, the American College of Chest Physicians, the American Thoracic Society, and the Society of Critical Care Medicine, published the report simultaneously in the July 1 issue of the American Journal of Respiratory and Critical Care Medicine and the July 2016 issues of Chest, the American Journal of Critical Care, and Critical Care Medicine.

The authors analyzed existing research to determine prevalence and causes for BOS so they could outline interventions.

The report notes that BOS may result in posttraumatic stress disorder, alcohol abuse, and even thoughts of suicide, and that consequences are evident for both providers and patient care.

BOS Affects Care Quality

Coauthor Marc Moss, MD, vice chair of clinical research for the Department of Medicine at the University of Colorado School of Medicine in Aurora and president-elect of the American Thoracic Society, said the report aims primarily to raise awareness about a silent syndrome.

"This should be acceptable to talk about," he said. "You have a cycle where you have your best employees thinking there's something wrong with them because they're having these symptoms, and they leave the job."

Although hospitals focus on readmissions and improving patient outcome measures, they neglect provider burnout, which can affect all facets of patient care, Dr Moss told Medscape Medical News. "I don't think it's on the radar as a priority."

He continued, "As one of the nurses in our [intensive care unit (ICU)] said, 'We can't take care of patients if we can't take care of each other and take care of ourselves.' "

BOS can permeate environments in which there is increasing workload with lack of control over the work environment and general breakdown in work relationships.

Adding to the stress is having to make ethical decisions, navigating relationships with patients and their families at a time when tensions are heightened over worries about their loved one's survival, and having to witness decisions to end life-prolonging measures.

Recommendations for Change

The authors call for change from patients and families, hospital administrators, educators, and professional societies. Their recommendations include:

  • Patient advocacy groups should educate patients and their families on the symptoms of BOS and how to have healthy interactions with providers. Fundraising to promote research in this sector can bring awareness and eventually lead to better patient outcomes. "They have a really strong voice, and if patients and families utilize that voice more effectively, they will raise awareness of this issue," Dr Moss said.

  • Hospital administrators should strive for low turnover rates as a sign the environment is welcoming for providers in addition to lowering costs of training. They should restrict the number of consecutive hours providers can work and provide assistance for those who have BOS or are at risk for it.

  • Hospitals should benchmark BOS so that ICUs could track their own progress and compare themselves with other ICUs. Dr Moss notes that this is not something he has seen quantified in hospitals, but one that could be valuable. "I would want to work in an ICU where there was less burnout syndrome."

  • Professional organizations can serve an important role in teaching providers the signs of BOS and how to ask for help.

  • Medical schools can improve outreach to incoming students and postgraduate students as to the realities of their profession and include coping skills in training. Burnout, once thought to be a problem of advanced careers, is emerging rapidly in the early-career stage, the authors note.

The authors have disclosed no relevant financial relationships.

Am J Respir Crit Care. 2016;194:106-113. Full text

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