Need for recovery amongst emergency physicians in the UK and Ireland: a cross-sectional survey

Abstract

ObjectivesTo determine the need for recovery (NFR) among emergency physicians and to identify demographic and occupational characteristics associated with higher NFR scores.DesignCross-sectional electronic survey.SettingEmergency departments (EDs) (n=112) in the UK and Ireland.ParticipantsEmergency physicians, defined as any registered physician working principally within the ED, responding between June and July 2019.Main outcome measureNFR Scale, an 11-item self-administered questionnaire that assesses how work demands affect intershift recovery.ResultsThe median NFR Score for all 4247 eligible, consented participants with a valid NFR Score was 70.0 (95% CI: 65.5 to 74.5), with an IQR of 45.5–90.0. A linear regression model indicated statistically significant associations between gender, health conditions, type of ED, clinical grade, access to annual and study leave, and time spent working out-of-hours. Groups including male physicians, consultants, general practitioners (GPs) within the ED, those working in paediatric EDs and those with no long-term health condition or disability had a lower NFR Score. After adjusting for these characteristics, the NFR Score increased by 3.7 (95% CI: 0.3 to 7.1) and 6.43 (95% CI: 2.0 to 10.8) for those with difficulty accessing annual and study leave, respectively. Increased percentage of out-of-hours work increased NFR Score almost linearly: 26%–50% out-of-hours work=5.7 (95% CI: 3.1 to 8.4); 51%–75% out-of-hours work=10.3 (95% CI: 7.6 to 13.0); 76%–100% out-of-hours work=14.5 (95% CI: 11.0 to 17.9).ConclusionHigher NFR scores were observed among emergency physicians than reported in any other profession or population to date. While out-of-hours working is unavoidable, the linear relationship observed suggests that any reduction may result in NFR improvement. Evidence-based strategies to improve well-being such as proportional out-of-hours working and improved access to annual and study leave should be carefully considered and implemented where feasible.

Need for recovery and physician well-being in emergency departments: national survey findings

“…All of the models were adjusted for potential confounding with previously identified associations with NFR score. [21] These included gender, study and annual leave, clinical grade, time working out of hours, long term health condition or disability, type of patients seen as fixed effects and registered sites as random effects. Models were fitted to participants with valid data for all variables included in the model.…”

“…The e-survey included the 11-item NFR scale plus an additional 44-items exploring demographic, occupational and well-being characteristics (online supplemental material 1). [21] A 'yes' response to an NFR item, with the exception of question four which is reversed, signals an unfavourable situation. The 11-items are then summated to give an overall score between 0 and 100, with each item contributing 9.09 to the total score.…”

Psychological distress and trauma in doctors providing frontline care during the COVID-19 pandemic in the United Kingdom and Ireland: a prospective longitudinal survey cohort study

“…The reported rates of distress and trauma do not take account of any pre-existing psychiatric morbidity or historical factors that may predispose doctors to developing mental health difficulties in these circumstances. [63][64][65][66] Data were gathered with regard to historical trauma, one of the most significant predictors of mental health difficulties long-term. Furthermore, while the sample size is large, any self-reporting measure is open to selection bias.…”

National Emergency Resuscitation Airway Audit (NERAA): a pilot multicentre analysis of emergency intubations in Irish emergency departments

“…NERAA is the first project performed by the newly established Irish Trainee Emergency Research Network (ITERN) following the success of the Trainee Emergency Research Network (TERN) in the UK [ 11 ]. The ITERN framework is made up of a central committee with co-investigators (CI) across the country.…”