Perceived Work Demands and Emergency Department Crowding as Predictors of Objective Stress among Emergency Physicians: A Shift-Level Approach

Abstract

Objective: To understand shift-level determinants of emergency physician (EP) burnout, relationships were tested between EP shift demands, stress, and fatigue.

Method: EP (N = 16) were assessed over 114 shifts that occurred before and during the COVID-19 pandemic. Salivary cortisol (an indicator of stress) and self-reported fatigue were collected prior to and following each shift. An objective crowding score (NEDOCS) per shift was calculated. Shift demands were assessed at the end of each shift.

Results: Multilevel models revealed that shift demands, NEDOCS, and the pandemic were related to higher levels of end-of-shift cortisol, but not fatigue. Cortisol levels were higher for shifts with a higher number of demands, greater crowding, and during the pandemic.

Conclusions: Shift demands predicted objective indicators of stress, but not self-reported fatigue. Interventions are needed to decrease stress and shift demands to reduce EP burnout.