RESUMEN
BACKGROUND: Resident physicians are at an increased risk of burnout due to their high-pressure work environments and busy schedules which can lead to poor mental health outcomes and decreased performance quality. Given variability among training programs and institutions across the United States, stressors likely differ, and interventions must be tailored to the local context, but few tools exist to assist in this process. METHODS: A tool commonly used in adverse event analysis was adapted into a "retrospective stressor analysis" (RSA) for burnout prevention. The RSA was tested in a group of chief residents studying quality improvement and patient safety in veteran's hospitals across the United States. The RSA prompted them to identify stressors experienced during their residencies across four domains (clinical practice, career development, personal life, and personal health), perceived causes of the stressors, and potential mitigation strategies. RESULTS: Fifty-eight chief residents completed the RSA. Within the clinical domain, they describe the stress of striving for efficiency and clinical skills acquisition, all while struggling to provide quality care in high pressure environments. In the career domain, identifying mentors and opportunities for research engagement was stressful. Within their personal lives, a lack of time-constrained their ability to maintain hobbies, relationships, and attend meaningful social events while also reducing their engagement in healthy behaviors such as exercise, optimal nutrition, and attending medical appointments. Within each of these domains, they identified and described stress mitigation strategies at the individual, departmental, and national levels. CONCLUSION: The RSA is a novel tool that can identify national trends in burnout drivers while simultaneously providing tailored prevention strategies for residents and their training sites.
Asunto(s)
Agotamiento Profesional , Internado y Residencia , Humanos , Agotamiento Profesional/prevención & control , Estados Unidos , Femenino , Masculino , Estudios Retrospectivos , AdultoRESUMEN
BACKGROUND: Arterial base deficit (ABD) measurement is a standard test for assessment of the trauma patient's metabolic response to shock. Venous blood is readily available earlier during the trauma resuscitation. The aim of this study is to analyze the difference (correlation, agreement, clinical significance) between the first peripheral venous base deficit (pVBD) and the first ABD during trauma resuscitation. METHODS: Consecutive trauma patients >18 years presenting to John Hunter Hospital (JHH), Newcastle, Australia, from January 2007 until July 2007 requiring arterial blood gas sampling had a peripheral venous blood gas performed simultaneously. A survey of JHH trauma clinicians and members of the American Association for the Surgery of Trauma was performed to determine a clinically relevant difference between two serial base deficit measurements. Pearson correlation and Bland-Altman tests were performed. RESULTS: During the 7-month period, 127 patients (79% men, mean age, 46.3 [±18.4 years] and median injury severity score of 15 [interquartile range, 8-23; range, 1-75]) were included into the study. The average peripheral ABD (pABD) and pVBD were -2.2 mmol/L±3.8 mmol/L and -1.3 mmol/L±3.8 mmol/L, respectively. The average difference between measurements was 0.9 (range, -1.7 to +3.5; 95% confidence interval, 0.7-1.0) with pVBD>pABD. The Pearson test showed highly significant correlation (r=0.97, p<0.0001). The survey of 11 JHH and 56 American Association for the Surgery of Trauma clinicians determined 2 mmol/L as clinically relevant difference between two base deficit measurements. All individual paired sample's difference sat within the clinically relevant limits and>95% (121 of 127) of samples sat within the 1.96 standard deviation acceptable by the Bland-Altman plot. CONCLUSION: There is near perfect correlation and clinically acceptable agreement between pABD and pVBD values on simultaneous testing. pVBD is an acceptable test to assess trauma patients' initial metabolic status when occult blood loss suspected.