The pace, pressures, work-life balance, and emotional aspects of a physician’s job put them at risk for burnout. A study by the American Medical Association and Mayo Clinic found that burnout rates were particularly increased for specialty practitioners. Drs. Nicholas Slamon and Rob Parker, pediatric ICU physicians at Nemours/Alfred I. duPont Hospital for Children in Wilmington, DE, used VivoSense® and real-time biometrics of physician stress to study its effects on the care of pediatric patients.
“Imagine a sick child being rushed into the hospital. This child is ashen, lethargic and not breathing. The parents are beyond distraught as they believed their two-week-old baby simply had her first cold. The team of care providers must make life or death decisions within a split second. These are some of the most stressful times we have in medicine,” says Dr. Rob Parker. “We believe that through studying how our bodies respond to these scenarios, we can look for ways to help our physicians make the right decisions, lower their stress levels, and achieve better patient outcomes.”
Drs. Nicholas Slamon and Robert Parker studied five physicians of varying gender and medical practice seniority. There were no exclusion criteria, as this was a voluntary study. They monitored and quantified PICU activities such as:
- Patient rounds (PR)
- Tracheal intubation (TI)
- Central line insertion (CL)
- A family meeting (FM)
- As a leader of a code blue activation (CB)
Through monitoring these activities, they were able to recognize biometric patterns that make performing tasks that predispose physicians to stress.
Study participants wore the Hexoskin™ Smart Shirt to monitor real-time biometrics during live, clinical patient conditions. They measured:
- Heart rate
- Respiratory rate
- Calories burned
- Heart rate variability
The Hexoskin™ smart shirt’s integrated activity sensor, respiratory sensor, and heart sensor measure data in real-time. Its state-of-the-art electrocardiograph sensor captures heart rate variability, acceleration and activity level, energy expenditure, breathing rate, minute ventilation, and calculation of oxygen consumption. The device is also capable of measuring inactivity and sleep parameters.
Data Quality Control
The researchers used VivoSense®, an all-inclusive software platform for analyzing raw physiological data, to manage the following as indicators of stress:
- ECG and respiratory artifact
- Identify and label key physiological events
- Derive heart rate variability
- Respiratory research metrics
The software automatically detected and removed or interpolated artifacts from ECG data, improving the accuracy of the data, and providing reliable measures of stress.
The pediatric physician’s day included numerous, potentially stressful procedures. VivoSense® integrated identified procedure times with the physiological data to provide relevant context to the HRV and respiratory metrics. It presented straightforward solutions to a complex study protocol.
Calculations of the data compared the subject baseline with the activities captured during their shift in the PICU. VivoSense® generated heart rate variability calculations and analysis following HRV standards of the European Society of Cardiology and the North American Society of Pacing Electrophysiology. The comparative analysis revealed the following:
- Patient Rounds: The duration of recordings ranged from 49 minutes, 51 seconds to 3 hours. The average HR was 85 ± 4.75 bpm. The HR of participants increased an average of 4.4 bpm (5.2%).
- Tracheal Intubation: The duration of recordings ranged from 9 minutes 2 seconds to 27 minutes, 47 seconds. The average heart rate was 99 ± 10.83 bpm. The HR of participants increased an average of 19.8 bpm (24.4%).
- Central Line Insertion: The duration of recordings ranged from 14 minutes, 9 seconds, to 40 minutes, 53 seconds. The average heart rate was 108 ± 8.97 bpm. The HR of participants increased an average of 27 bpm (34.3%).
The study showed that critical care activities such as tracheal intubation and central line insertion standard deviation ratios indicated a high degree of sympathetic activation during the procedures. The small number of participants and the inability to compare between training levels of the physicians notably limited the study. The variables of chronic and acute stressors, call shift variation, patient complexity, and census volume also need to be considered.
This research is one of the first to look at how on-the-job stress affects the vital signs of medical providers. With the current interest in burnout and workplace fatigue, the hope is that this research opens new doors to how physicians can learn to decrease perceived stressors.