Objective This study explored the perspectives and behaviours of emergency physicians (EPs), regularly involved in resuscitation, to identify the sources and effects of any stress experienced during a resuscitation as well as the strategies employed to deal with these stressors.
Methods This was a two-centre sequential exploratory mixed-methods study of EPs consisting of a focus group, exploring the human factors related to resuscitation, and an anonymous survey. Between April and June 2020, the online survey was distributed to all EPs working at Australia’s largest two major trauma centres, both in Melbourne, and investigated sources of stress during resuscitation, impact of stress on performance, mitigation strategies used, impact of the COVID-19 pandemic on stress and stress management training received. Associations with gender and years of clinical practice were also examined.
Results 7 EPs took part in the focus group and 82 responses to the online survey were received (81% response rate). The most common sources of stress reported were resuscitation of an ‘unwell young paediatric patient’ (81%, 95% CI 70.6 to 87.6) or ‘unwell pregnant patient’ (71%, 95% CI 60.1 to 79.5) and ‘conflict with a team member’ (71%, 95% CI 60.1 to 79.5). The most frequently reported strategies to mitigate stress were ‘verbalising a plan to the team’ (84%, 95% CI 74.7 to 90.5), ‘implementing a standardised/structured approach’ (73%, 95% CI 62.7 to 81.6) and ‘asking for help’ (57%, 95% CI 46.5 to 67.5). 79% (95% CI 69.3 to 86.6) of EPs reported that they would like additional training on stress management. Junior EPs more frequently reported the use of ‘mental rehearsal’ to mitigate stress during a resuscitation (62% vs 22%; p<0.01) while female EPs reported ‘asking for help’ as a mitigator of stress more frequently than male EPs (79% vs 47%; p=0.01).
Conclusions Stress is commonly experienced by EPs during resuscitation and can impact decision-making and procedural performance. This study identifies the most common sources of stress during a resuscitation as well as the strategies that EPs use to mitigate the effects of stress on their performance. These findings may contribute to the development of tailored stress management training for critical care clinicians.
Data availability statement
Data are available upon reasonable request. The data underlying this article will be shared on reasonable request to the corresponding author.
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Handling editor Ellen J Weber
Contributors All authors made substantial contributions. CG, AM, DA, SES and MF did the conception and design of the study. CG, AM, DA, NW and YK did the data acquisition. CG, SES and MF did data analysis and interpretation. CG, AM, DA, NW and YK drafted the article. SES, DVS and MF revised critically for intellectual content. All authors have given approval of the version submitted. CG is the guarantor and accepts full responsibility for the finished work and the conduct of the study, had access to the data, and controlled the decision to publish.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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