Burnout amongst emergency healthcare workers during the COVID-19 pandemic: A multi-center study

Abstract

Burnout is a major healthcare issue [1] which has intensified with additional stressors arising from the ongoing 2019 Novel Coronavirus (COVID-19) pandemic [2,3]. Emergency Department (ED) healthcare workers (HCWs) have had one of the highest incidences of burnout [4][5][6] even prior to the pandemic. Being at the frontline in direct contact with patients suspected or confirmed to have a COVID-19 infection exacerbates this [7].To evaluate the prevalence of burnout in this population and the preferred methods of coping with the COVID-19 situation, we conducted a cross-sectional study amongst doctors and nurses in our regional health cluster's Emergency Departments (EDs) and Urgent Care Center (UCC). This was performed in end-May, three months into an escalation of hospital workflows in response to the pandemic, at which time Singapore had seen more than 30,000 cases of COVID-19 infections [8]. Approval from the relevant institutional review board was obtained for waiver of consent. Anonymized data was collected via an online questionnaire which covered sociodemographic data, COVID-19 related anxiety and stress as well as coping strategies. These questions were developed based on previous studies and expert opinions on mental health and coping in infectious disease outbreaks [9][10][11]. We evaluated for burnout using the Copenhagen Burnout Inventory (CBI) [12].The primary outcome was the proportion of moderate-to-severe burnout amongst the HCWs, defined by a score of 50 or higher in the personal domain of the CBI. Secondary outcomes assessed included factors associated with moderate-to-severe burnout and preferred methods of coping with the COVID-19 situation.A total of 337 HCWs (210 nurses and 127 doctors) participated in the survey. The overall response rate was 60.2% (69.4% for doctors and 55.7% for nurses). The most common age range was between 21 and 30 years old (46.4%). Majority of respondents were female (67.7%). Most respondents (84.6%) had already been working in the ED or UCC prior to the COVID-19 pandemic while the rest were deployed to augment departmental manpower.Using the CBI, the mean score of personal burnout was 49.2 (SD 18.6). A significant proportion of respondents reported moderate-tosevere personal burnout (49.3%). Nurses had significantly higher CBI scores than doctors, with the mean personal burnout scores for nurses

Nurses’ burnout and associated risk factors during the COVID-19 pandemic: a systematic review and meta-analysis

“…After the screening of the titles and abstracts, we removed 191 records and we added 4 more records found by the reference lists scanning. Finally, we included 14 studies [27][28][29][30][31][32][33][34][35][36][37][38][39][40] in this systematic review that met our inclusion criteria and among them six studies in the meta-analysis that included the appropriate data.…”

“…Main characteristics of the 14 studies included in our systematic review are shown in Table 1. Study population included only nurses in five studies, 27,28,33,36,40 while nine studies [29][30][31][32]34,35,[37][38][39] included HCWs in general. A total of 17,390 nurses were included in this systematic review, while two studies 37,38 did not report the number of nurses.…”

“…A total of 17,390 nurses were included in this systematic review, while two studies 37,38 did not report the number of nurses. All studies were cross-sectional, while 12 studies [27][28][29][30][33][34][35][36][37][38][39][40] used a convenience sample method and two studies 31,32 used a snowball sampling method. Eight studies 27,28,30,[33][34][35]37,40 was conducted in Asia (China, India, Japan, Turkey, Singapore, Taiwan, and Iran), four studies 29,32,36,39 in Europe (United Kingdom, Spain, and Italy), and two studies 31,38 in North America (USA and Puerto Rico).…”

“…All studies were cross-sectional, while 12 studies [27][28][29][30][33][34][35][36][37][38][39][40] used a convenience sample method and two studies 31,32 used a snowball sampling method. Eight studies 27,28,30,[33][34][35]37,40 was conducted in Asia (China, India, Japan, Turkey, Singapore, Taiwan, and Iran), four studies 29,32,36,39 in Europe (United Kingdom, Spain, and Italy), and two studies 31,38 in North America (USA and Puerto Rico). Eleven studies [27][28][29][30]33,34,[36][37][38][39][40] were published in journals and three studies 31,32,35 in pre-print services.…”

“…Quality was moderate in the majority of studies (n=12) 29,[29][30][31][32][33][34][35][36][37][38][39][40] and good in two studies 27,28 . The most frequent bias is that the studies did not take into account confounding factors and did not apply multivariable methods to eliminate them.…”