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Journal of Integrative Medicine ›› 2019, Vol. 17 ›› Issue (3): 173-180.doi: 10.1016/j.joim.2019.03.009

• Original Clinical Research • Previous Articles     Next Articles

Burnout in the emergency department: Randomized controlled trial of an attention-based training program

Pádraic  J.Dunnea, 1, Julie Lynchb, 1, Lucia Prihodovab, Caoimhe O'Learyb, Atiyeh Ghoreyshic, Sharee A. Basdeod, Donal J.Coxd, Rachel Breenb, Ali Sheikhid, Áine Carrolle, Cathal Walshd, Geraldine McMahonf, Barry Whiteg   

  1. a Trinity Translational Medicine Institute, Trinity College, Dublin D08 W9RT, Ireland
    b Research Department, Royal College of Physicians of Ireland, Dublin D02 E434, Ireland
    c Department of Innovation, Fitbit Inc., San Francisco, CA 94105, USA
    d Health Research Institute, Main Building, University of Limerick, Limerick V94 X5K6, Ireland
    e Health Service Executive, Dr Steevens’ Hospital, Dublin D08 W2A8, Ireland
    f Department of Emergency Medicine, St. James’s Hospital, Dublin D08 W9RT, Ireland
    g National Centre for Hereditary Coagulation Disorders, St. James’s Hospital, Dublin D08 W9RT, Ireland
  • Received:2018-11-23 Accepted:2019-03-14 Online:2019-05-05 Published:2019-05-17

Background
Burnout (encompassing emotional exhaustion, depersonalization and personal accomplishment) in healthcare professionals is a major issue worldwide. Emergency medicine physicians are particularly affected, potentially impacting on quality of care and attrition from the specialty.
Objective
The aim of this study was to apply an attention-based training (ABT) program to reduce burnout among emergency multidisciplinary team (MDT) members from a large urban hospital.
Design, setting, participants and interventions
Emergency MDT members were randomized to either a no-treatment control or an intervention group. Intervention group participants engaged in a four session (4?h/session) ABT program over 7?weeks with a practice target of 20?min twice-daily. Practice adherence was measured using a smart phone application together with a wearable Charge 2 device.
Main outcome measures
The primary outcome was a change in burnout, comprising emotional exhaustion, depersonalization and personal achievement. The secondary outcomes were changes in other psychological and biometric parameters.
Results
The ABT program resulted in a significant reduction (P?<?0.05; T1 [one week before intervention] vs T3 [follow-up at two months after intervention]) in burnout, specifically, emotional exhaustion, with an effect size (probability of superiority) of 59%. Similar reductions were observed for stress (P?<?0.05) and anxiety (P?<?0.05). Furthermore, ABT group participants demonstrated significant improvements in heart rate variability, resting heart rate, sleep as well as an increase in pro-inflammatory cytokine expression.
Conclusion
This study describes a positive impact of ABT on emergency department staff burnout compared to a no-treatment control group.
Trial registration
ClinicalTrials.gov identifier NCT02887300.

Key words: Burnout, Emotional exhaustion, Meditation, Healthcare professional, Sleep, Stress, Cytokines, Cortisol, Randomized controlled trial

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