The Quiet Threat of Post-Pandemic Healthcare Worker Fatigue on Inpatient Safety Outcomes
DOI:
https://doi.org/10.5281/zenodo.20443594Keywords:
Pandemic; Burnout; Patient Safety; Acute Care; Healthcare Organizations; Crisis Management;Workforce burnout;Pandemic-related stress;Patient safety outcomes;Acute care hospitals;Healthcare worker fatigue;Nurse burnout;Physician burnout;Medical errors;Quality of care;Occupational stress;Staffing shortages;Mental health of healthcare workers;Clinical performance;Safety culture;Healthcare system resilience.Abstract
Burnout is an occupational hazard in healthcare, often linked to reduced quality and safety. An investigation on the relationship between such problems induced by the COVID-19 pandemic and patient safety in acute-care hospitals is especially timely. Analysis of burnout trajectories suggests chronic levels of emotional exhaustion among nurses and support staff and sustained elevations in depersonalization among nurses throughout the pandemic. Evidence that higher burnout correlates with increased rates of medical errors or adverse events, a weakened safety culture, and negative reporting attitudes provides a foundation for associated decreases in patient safety. Although several mechanisms have been proposed, none have been directly tested. The elevated level of pandemic-related stressors faced by acute-care hospitals may exacerbate the usual burnout–safety relationship. Nevertheless, the available information remains useful for guiding practical action, future research, and persuasively informing policy.
References
[1] Alsulimani, L. K., Farhat, A. M., Borah, R. A., AlKhalifah, J. A., Alyaseen, S. M., Alghamdi, S. M., Alhomaidan, H. T., Alhomaidan, A. T., & AlShehri, N. S. (2021). Health care worker burnout during the COVID-19 pandemic: A cross-sectional survey study. Saudi Medical Journal, 42(3), 306–314. doi:10.15537/smj.2021.42.3.20200790
[2] Carmassi, C., Foghi, C., Dell’Oste, V., Cordone, A., Bertelloni, C. A., Bui, E., & Dell’Osso, L. (2020). PTSD symptoms in healthcare workers facing the three coronavirus outbreaks: What can we expect after the COVID-19 pandemic. Psychiatry Research, 292, 113312. doi:10.1016/j.psychres.2020.113312
[3] Cheung, K. W., & Tam, W. (2022). Physician burnout during the COVID-19 pandemic. BC Medical Journal, 64(2), 58–62.
[4] de Lima Garcia, C., de Abreu, L. C., Ramos, J. L. S., de Castro, C. F. D., Smiderle, F. R. N., dos Santos, J. A., & Bezerra, I. M. P. (2019). Influence of burnout on patient safety: Systematic review and meta-analysis. Medicina, 55(9), 553. doi:10.3390/medicina55090553
[5] Dzau, V. J., Kirch, D., & Nasca, T. (2020). Preventing a parallel pandemic—A national strategy to protect clinicians’ well-being. The New England Journal of Medicine, 383(6), 513–515. doi:10.1056/NEJMp2011027
[6] Elhadi, M., Msherghi, A., Elgzairi, M., Alhashimi, A., Bouhuwaish, A., Biala, M., Abuelmeda, S., Khel, S., Khaled, A., Alsoufi, A., & others. (2020). Burnout syndrome among hospital healthcare workers during the COVID-19 pandemic and civil war: A cross-sectional study. Frontiers in Psychiatry, 11, 579563. doi:10.3389/fpsyt.2020.579563
[7] Galanis, P., Vraka, I., Fragkou, D., Bilali, A., & Kaitelidou, D. (2021). Nurses’ burnout and associated risk factors during the COVID-19 pandemic: A systematic review and meta-analysis. Journal of Advanced Nursing, 77(8), 3286–3302. doi:10.1111/jan.14839
[8] Hall, L. H., Johnson, J., Watt, I., Tsipa, A., & O’Connor, D. B. (2016). Healthcare staff wellbeing, burnout, and patient safety: A systematic review. PLOS ONE, 11(7), e0159015. doi:10.1371/journal.pone.0159015
[9] Hartzband, P., & Groopman, J. (2020). Physician burnout, interrupted. The New England Journal of Medicine, 382(26), 2485–2487. doi:10.1056/NEJMp2003149
[10] Hlubocky, F. J., Symington, B. E., McFarland, D. C., Gallagher, C. M., Weller, M., & others. (2021). Impact of the COVID-19 pandemic on oncologist burnout, emotional well-being, and moral distress: Considerations for the cancer organization’s response. JCO Oncology Practice, 17(7), 365–374. doi:10.1200/OP.20.00937
[11] Hines, S. E., Chin, K. H., Glick, D. R., & Wickwire, E. M. (2021). Trends in moral injury, distress, and resilience factors among healthcare workers at the beginning of the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 18(2), 488. doi:10.3390/ijerph18020488
[12] Jalili, M., Niroomand, M., Hadavand, F., Zeinali, K., & Fotouhi, A. (2021). Burnout among healthcare professionals during COVID-19 pandemic: A cross-sectional study. International Archives of Occupational and Environmental Health, 94(6), 1345–1352. doi:10.1007/s00420-021-01695-x
[13] Kabunga, A., Anyayo, L., & others. (2021). Prevalence and predictors of burnout among nurses during COVID-19: A cross-sectional study in hospitals managing COVID-19 patients. BMJ Open, 11(9), e054284. doi:10.1136/bmjopen-2021-054284
[14] Kakemam, E., Chegini, Z., Rouhi, A., Ahmadi, F., Majidi, S., & Ghobadi, A. (2021). Burnout and its relationship to self-reported quality of patient care and adverse events during COVID-19: A cross-sectional study among nurses. Journal of Nursing Management, 29(7), 1974–1982. doi:10.1111/jonm.13359
[15] Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., Wu, J., Du, H., Chen, T., Li, R., Tan, H., Kang, L., Yao, L., Huang, M., Wang, H., Wang, G., Liu, Z., & Hu, S. (2020). Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open, 3(3), e203976. doi:10.1001/jamanetworkopen.2020.3976
[16] Lasalvia, A., Bonetto, C., Porru, S., Carta, A., Tardivo, S., Bovo, C., Ruggeri, M., & Amaddeo, F. (2021). Levels of burn-out among healthcare workers during the COVID-19 pandemic and their associated factors: A cross-sectional study in a tertiary hospital. BMJ Open, 11(1), e045127. doi:10.1136/bmjopen-2020-045127
[17] Liu, Q., Luo, D., Haase, J. E., Guo, Q., Wang, X. Q., Liu, S., Xia, L., Liu, Z., Yang, J., & Yang, B. X. (2020). The experiences of health-care providers during the COVID-19 crisis in China: A qualitative study. The Lancet Global Health, 8(6), e790–e798. doi:10.1016/S2214-109X(20)30204-7
[18] Mantri, S., Song, Y. K., Lawson, J. M., Berger, E. J., & Koenig, H. G. (2021). Moral injury and burnout in health care professionals during the COVID-19 pandemic. The Journal of Nervous and Mental Disease, 209(10), 720–726. doi:10.1097/NMD.0000000000001367
[19] Menon, G. R., Yadav, J., Aggarwal, S., Singh, R., & others. (2022). Psychological distress and burnout among healthcare workers during COVID-19 pandemic in India: A cross-sectional study. PLOS ONE, 17(3), e0264956. doi:10.1371/journal.pone.0264956
[20] Muller, A. E., Hafstad, E. V., Himmels, J. P. W., Smedslund, G., Flottorp, S., Stensland, S. Ø., Stroobants, S., Van de Velde, S., & Vist, G. E. (2020). The mental health impact of the COVID-19 pandemic on healthcare workers, and interventions to help them: A rapid systematic review. Psychiatry Research, 293, 113441. doi:10.1016/j.psychres.2020.113441
[21] Panagioti, M., Geraghty, K., Johnson, J., Zhou, A., Panagopoulou, E., Chew-Graham, C., Peters, D., Hodkinson, A., Riley, R., & Esmail, A. (2018). Association between physician burnout and patient safety, professionalism, and patient satisfaction: A systematic review and meta-analysis. JAMA Internal Medicine, 178(10), 1317–1331. doi:10.1001/jamainternmed.2018.3713
[22] Pappa, S., Ntella, V., Giannakas, T., Giannakoulis, V. G., Papoutsi, E., & Katsaounou, P. (2020). Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain, Behavior, and Immunity, 88, 901–907. doi:10.1016/j.bbi.2020.05.026
[23] Prasad, K., McLoughlin, C., Stillman, M., Poplau, S., Goelz, E., Taylor, S., Nankivil, N., Brown, R., Linzer, M., Cappelucci, K., & Sinsky, C. A. (2021). Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: A national cross-sectional survey study. EClinicalMedicine, 35, 100879. doi:10.1016/j.eclinm.2021.100879
[24] Restauri, N., & Sheridan, A. D. (2020). Burnout and posttraumatic stress disorder in the coronavirus disease 2019 (COVID-19) pandemic: Intersection, impact, and interventions. Journal of the American College of Radiology, 17(7), 921–926. doi:10.1016/j.jacr.2020.05.021
[25] Shanafelt, T., Ripp, J., & Trockel, M. (2020). Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. JAMA, 323(21), 2133–2134. doi:10.1001/jama.2020.5893
[26] Sharifi, M., Asadi-Pooya, A. A., & Mousavi-Roknabadi, R. S. (2020). Burnout among healthcare providers of COVID-19: A systematic review. International Journal of Preventive Medicine, 11, 186. doi:10.4103/ijpvm.IJPVM_327_20
[27] Song, Y. K., Mantri, S., Lawson, J. M., Berger, E. J., & Koenig, H. G. (2021). Morally injurious experiences and emotions of health care professionals during the COVID-19 pandemic before vaccine availability. JAMA Network Open, 4(11), e2136150. doi:10.1001/jamanetworkopen.2021.36150
[28] Sun, P., Wang, M., Song, T., Wu, Y., Luo, J., Chen, L., Yan, L., & others. (2021). The psychological impact of COVID-19 pandemic on health care workers: A systematic review and meta-analysis. Frontiers in Psychology, 12, 626547. doi:10.3389/fpsyg.2021.626547
[29] Walton, M., Murray, E., & Christian, M. D. (2020). Mental health care for medical staff and affiliated healthcare workers during the COVID-19 pandemic. European Heart Journal: Acute Cardiovascular Care, 9(3), 241–247. doi:10.1177/2048872620922795
[30] West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: Contributors, consequences and solutions. Journal of Internal Medicine, 283(6), 516–529. doi:10.1111/joim.12752
[31] World Health Organization. (2020). Patient safety incident reporting and learning systems: Technical report and guidance. World Health Organization.
[32] Zhang, Y., Wang, C., Pan, W., Zheng, J., Gao, J., Huang, X., Cai, S., Zhai, Y., Latour, J. M., & Zhu, C. (2020). Stress, burnout, and coping strategies of frontline nurses during the COVID-19 epidemic in Wuhan and Shanghai, China. Frontiers in Psychiatry, 11, 565520. doi:10.3389/fpsyt.2020.565520
Additional Files
Published
Data Availability Statement
The paper relies entirely on previously published studies, meta-analyses, and secondary sources. No new dataset was generated.
