Notes from Rounds: On The Floor at SCCM's Annual Critical Care Congress

In an effort to diversify on-site coverage at meetings and conferences throughout the year, HCPLive® created Notes from Rounds—a program where we enlist the aid of aspiring medical students, fellows, and early career providers to document key takeaways from the sessions they attend.

Adam Sturts, MSIV, a fourth-year medical student at Rowan University School of Osteopathic Medicine, volunteered to contribute to HCPLive's Notes from Rounds while attending the Society of Critical Care Medicine (SCCM) 49^th Annual Critical Care Congress (CCC 49) in Orlando, FL. In addition to providing insights and coverage of the meeting, Sturts also presented a study he took part in with colleagues from Inspira Health Network in Vineland, NJ, titled "Predischarge decision tree analysis predicts 30-day congestive heart failure readmission”.

On the Floor at CCC 49

Below is Sturts' journal of notes on the sessions he attended at CCC 49 throughout the conference. Medical students, care providers, and experts interested in contributing to MD Mag coverage can contact us here.CCC 49 began on February 16, 2019 with the SCCM Presidential Address in which President Lewis Kaplan, MD, FACS, FCCM, a surgical intensivist at Perelman School of Medicine at the University of Pennsylvania, began his speech with a description of his experience in the ICU—not as a physician but as a patient.

“The spark that ignited my passion led me to both critical care and the OR—initially, as a surgeon and later as a patient,” Kaplan explained in his address. “A touch over 38 and a half years, rushed me headlong into several life-altering discoveries. The pain of myocardial ischemia, that 1 mg of midazolam is insufficiently sedating in the cath lab.”

“And that despite a tightly wired sternotomy after 4 coronary bypasses, effective analgesia eluded my grasp, and still does on rainy days. I extubated rapidly and promptly enjoyed widespread atelectasis and hypoxia,” he continued.

The distress that he and his family experienced during this hospitalization inspired his interest in SCCM’s THRIVE Initiative and Post-Intensive Care Syndrome (PICS) research. PICS is made up of health problems that remain after critical illness involving the patient’s body, thoughts, feelings, or mind and may affect family as well. Through the THRIVE Initiative, SCCM hopes to educate patients, their families, and healthcare community about PICS and provide resources.

Burnout in ICUs

Kaplan also touched upon some of the recent highlights in intensive care medicine, including the “Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children,” recently published in Pediatric Critical Care Medicine. Additionally, Kaplan noted SCCM continues to collaborate with the European Society of Intensive Care Medicine on the Surviving Sepsis Campaign.During my time at CCC 49, burnout seemed to be one of the recurring themes. Personally, I was surprised to learn that up to 45% of critical care physicians reported symptoms of severe burnout syndrome (BOS). Also of note, 25% to 33% of critical care nurses manifest symptoms of severe BOS.

This high BOS rate in critical care professionals might be attributed to the stressful environment of the ICU secondary to high patient morbidity, mortality, and frequent encounters with traumatic and ethical issues.

I frequently discuss burnout with colleagues on my clinical rotations. It is a healthcare epidemic with huge impact on both practitioners and the patients that they treat. Maintaining our own physical and mental health is essential as it facilitates optimal patient care.

I walked through the exhibit hall contemplating strategies for reducing burnout and achieving wellness when I stumbled upon a Research Snapshot Presentation entitled “Burnout Interventions Should Target Sociocultural Factors,” by Nupur Dalal, MD, a third-year pediatric critical care fellow from Emory University in Savannah, GA.

“What is unknown is what specific aspects of the organization contribute to burnout. What we aimed to do was to find the specific aspects of the organization that lead to burnout and figure out which ones are most closely linked,” Dalal said during his presentation.

Dalal’s study was a cross-sectional, multidisciplinary point prevalence study conducted across 5 intensive care units in a children’s hospital aimed to delineate factors within the work environment/organization and their contribution to burnout. Participants included physicians, respiratory therapists, nurses, and pediatric practice providers.

The factors assessed by Dalal and fellow investigators included demographics, organizational culture and support, relationship quality, conflict frequency, and work schedules. The primary outcome of the study was burnout, which was defined as an endorsement of symptoms related to emotional exhaustion or depersonalization at least once a week.

Upon analysis, 39.7% of survey participants reported burnout and burnout did not vary significantly by demographic, full-time status, ICU experience or work schedule. Respiratory therapists were at highest risk of burnout with 2.35 times greater odds of experiencing burnout as compared to physicians (95% CI 95% CI, 1.03-5.57, P = .042]. Dalal’s analysis also found working in the NICU was associated with about half the odds of burnout as other unit types (PICU OR: 0.53, 95% CI, 0.32-0.84), P = .007; CICU OR: 0.52, 95% CI, 0.28-0.98, P = .043).

Greater perceptions of aggressive-defensive cultures (OR 1.15, 95% CI, .07-1.22, P< .001) and more conflict were associated with increased odds of burnout (OR 1.26, 95% CI, 1.13-1.40, P< .001). While greater perceptions of organizational support (OR: 0.94, 0.92-0.96, P< .001), constructive culture (OR: 0.84, 95% CI, 0.78-0.90, P< .001) and better relationship quality (OR: 0.56, 95% CI 0.45-0.70, P< .001) were all associated with reduced odds of burnout.

As demonstrated by the study’s results, the most significant factors of burnout included the absence of organizational support, increased number of conflicts, and absence of the constructive culture.

I caught up with Dalal after his presentation to get more perspective on his insights into burnout.

“It is important to look at burnout as a relationship and we must heal this relationship. Exploring relationships with the organization, with our colleagues and leadership and with our approach to work itself are key aspects to solving the epidemic of burnout,” Dalal said.