Critical Care Commentary: Is it time to deconstruct the idea of intensive care unit burnout?
Given these observations, it is apparent that the ICU is a double-edged sword, one that provides remarkable degrees of physical healing for many people, yet causes profound emotional harm in others. However, these entities have remained compartmentalized until this point in time: burnout occurs only in the health-care providers, PTSD is the domain of the patients, and depression is seen among the caregivers. But perhaps these apparently separate entities are actually interconnected and represent points on the bigger spectrum of critical illness-associated burnout (for lack of a better term). Although the data regarding risk factors for burnout/PTSD/depression are not robust, there is significant overlap of these items (gender, age/experience, satisfaction domains, degrees of conflict, emotional decision making) among providers, patients, and caregivers. Is this yet another signal that these entities may be more similar than they are different? At the end of the day, perhaps we have even more in common with our ICU patients and their caregivers than we have previously recognized.
A critically important reason to better understand the interconnectedness of these entities (or lack thereof) lies with our ability to eventually provide meaningful prevention strategies. Effective interventions for reducing health-care provider burnout have included resilience training and rotating responsibilities to mandate tours of duty outside the ICU are interspersed with brief (less than 2 weeks) ICU stretches. In the ICU patient population, a daily care diary has been associated with a significant reduction in PTSD symptoms. The data are scant regarding prevention of caregiver depression but one small study of journaling and reflection suggests benefit. To date, no strategy with efficacy in one cohort has been extrapolated to another.
As such, we have a significant task ahead of us. We need to better understand the ICU-related burnout/PTSD/depression syndrome and to delineate its common ground for clinicians, patients, and families. With ongoing evaluation and reflection, we will ultimately evolve ICU care to the point where interrelated strategies are employed that allow us to effectively heal patients physically while avoiding this critical care burnout syndrome that insidiously affects us all.
Dr. Morrow is Section Editor of Critical Care Commentary.
