BackgroundIn an emergency room of internal medicine, triage and treatment of patients deserve first priority. However, biopsychosocial case complexity may also affect patient health outcome but has not yet been explored in this setting. Therefore, the aims of the study are (1) to estimate prevalence rates of complex patients in the emergency room (ER), (2) to describe biopsychosocial complexity in this population and (3) to evaluate possible correlations between patient profiles regarding case complexity and further clinical treatment.MethodsDuring a study period of one week, all patients of an emergency room of internal medicine who were triaged to Manchester levels three to five were invited to participate in the study. Biopsychosocial case complexity was assessed by the INTERMED method. Psychosocial interventions were evaluated based on all documented interventions and recommendations given at the emergency room and during inpatient treatment.ResultsStudy participants consisted of 167 patients with a subgroup of 19% (n = 32) receiving subsequent inpatient-treatment at the department. High biopsychosocial case complexity was found in 12% (n = 20) of the total sample (INTERMED score >20). This finding was paralleled by a cluster analysis suggesting three clusters with one highly complex patient group of 14%. These highly complex patients differed significantly from the other clusters as they had visited the emergency room more often within the last year and lived alone more frequently. In addition, admission rates were highest in this group. During ER treatment and subsequent inpatient treatment, 21% of highly complex patients received interventions addressing psychosocial factors as compared to 6% and 7%, respectively, in the other clusters.ConclusionsA standardized screening of biopsychosocial case complexity among ‘frequent utilizers’ of the ER would be helpful to detect specific multidisciplinary health care needs among this particularly burdened patient group.
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Abstract:The medical staffs in health service institutions are often required to spend time in intense involvement with other people. Frequently, the staff-client interaction is centred on the client's current problems (physical, psychological, social) and is therefore charged with feelings of pain and suffering, fear, despair, turmoil and anger.The main aim of our meeting is to discuss the consequences of such personal burdens as well as to get a better insight into the background of professional burnout phenomenon in general. Because a burnout could not be only the result of job characteristics but could appear also as the result of work organization type, social relationships, as well as of some personal characteristics and individual′s life style, too, it is essential to look for the forms of support not only on the individual, but it is necessary to consider also the preventive options at the institutional level. How to define burnout? It was estimated that over 6,000 books, chapters, dissertations, and journal articles have been published on burnout since this phenomenon has elicited the attention of researchers. Despite this, there is no single definition of burnout that has been accepted as a standard yet. Frequently cited definition of burnout according to Maslach and Jackson pointed out that burnout is a process of emotional exhaustion, depersonalisation, and reduced personal accomplishment that occur among individuals who do »people work« of some kind. It corresponds to the most widely used self-reported questionnaire MBI, which includes all three dimensions that are mentioned in this definition.According to Siegrist′s ERI model the trigger factor for the occurrence of job burnout signs is the effort-reward imbalance. The ERI model claims that the work role is crucial in order to fulfil individual self-regulatory needs because it offers opportunities to acquire self-efficacy, self-esteem, and self-integration. Based on the principle of social reciprocity, the employee invests efforts and expects rewards in return. However, in case the imbalance is present between high effort and low reward, this taken-for-granted routine is disrupted and the fulfilment of individual′s needs for autonomy, competence, and relatedness is threatened. Resulting disproportion may lead to a state of ''active distress'' by evoking strong negative emotions, which in turn sustained activation of the autonomic nervous system and may contribute to the development of physical (e.g. cardiovascular) as well as mental (e.g. depression) diseases.But the importance of balance between input and perceived effects at the job is not the only one that provides the individual with a sense of well-being. Important is also balance between different human′s life roles.But why is it necessary to be familiar with this phenomenon? How is it shown in medical practice, what triggers it, what are the consequences, and above all, how to protect oneself against it?Edelwich and Brodsky have highlighted that in helping professions burnout may be expres...
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