Putting the joy back in medicine: proven strategies to reduce burnout

Susan Corbridge, PhD, ACNP, FAAN, FAANP, FCCP,

Burnout is especially a problem in health care. It’s not just the 67% of physicians who self-report symptoms of burnout—it’s nurses, respiratory therapists, and every other subset of health-care providers.

“Burnout wreaks havoc on patient care,” said Susan Corbridge, PhD, ACNP, FAAN, FAANP, FCCP, clinical professor of nursing and of medicine at the University of Illinois Chicago. “Burnout leads to lower patient satisfaction, reduced adherence to treatment plans, increased medical errors, unprofessional conduct. Providers withdraw from patient relationships. It is important that we take steps to reduce burnout.”

Dr. Corbridge discussed the advantages of team-based care during a prerecorded plenary session on Finding Joy in Medicine: Proven Strategies. The session recordings are available for viewing on the virtual CHEST 2020 meeting platform through January 18, 2021, for registered attendees.

Bindu Akkanti, MD, FCCP, director of heart and vascular critical care and associate professor of medicine at Memorial Hermann-Texas Medical Center at the University of Texas McGovern Medical School, reviewed the data supporting mindfulness training, stress management, and small group discussions.

Bindu Akkanti, MD, FCCP, FAANP, FCCP
Bindu Akkanti, MD, FCCP, FAANP, FCCP

The problem is not convincing health-care providers that these kinds of interventions can help manage stress and reduce the symptoms of burnout, Dr. Akkanti said. The problem is convincing health systems and practices that they are worth the investment.

“We need to make the business case for intervention to reduce burnout,” she said. “The data show that if organizations invest resources in interventions to reduce burnout, there will be a very positive return on their investment.”

For hospitals, reducing stressors that contribute to burnout can be as straightforward as addressing alarm fatigue. The Joint Commission has already identified reducing alarms as a National Patient Safety Goal.

“There are too many alarms,” said J. Brady Scott, PhD(c), RRT, FCCP, associate professor and director of clinical education at Rush University. “In the ICU, it seems like in every direction, there is a new alarm. Providers become desensitized to alarm sounds, ignore them, turn alarms off, adjust settings. All of these actions can have serious, even fatal consequences.”

J. Brady Scott, PhD(c), RRT, FCCP
J. Brady Scott, PhD(c), RRT, FCCP

He noted that of 98 sentinel event alarms reported to the joint commission in one 30-month period, 80 resulted in patient death, 13 in permanent loss of function, and five in unexpected additional care or extended stay.

At the same time, studies suggest that between 2/3 and 3/4 of all alarms are not helpful or not actionable. The typical ICU RT or clinician is exposed to nine mechanical ventilation alarms and 7.8 physiologic alarms every hour, leading to increased stress, increased fatigue, decreased concentration, fatigue, and tension headaches.

A common example is ECG leads sounding sound alarms for apnea and respiratory rate issues when the patient is on mechanical ventilation.

“That’s not a valid alarm,” he said. “That’s noise you have to filter out.”

COVID-19 has only increased provider stress and burnout. Before COVID-19, up to 78% of health-care providers reported burnout symptoms, Dr. Corbridge noted.

A recent survey by the Society of Critical Care Medicine found that the mean burnout score reported by hospital staff jumped from three to eight during the pandemic.

Team care can help reduce stress and burnout. Data consistently show effective team practice improves patient outcomes, improves patient satisfaction, and provides more cost-effective care than conventional practice models, reducing provider stress.

Team care also provides backup.

“Team skill sets are better than any individual skill set,” she said. “Team care improves relationships between providers and improves job satisfaction. And coworker support reduces emotional distress because no one knows what you are going through like a colleague. We really are in this together.”