Irregular hours, long nights, quick decisions, and a never-ending flow of pediatric patients with urgent needs accompanied by concerned parents. This is the life of a clinician working in a pediatric emergency department.
To better understand this challenging environment, Mustafa Ozkaynak, PhD, Associate Professor at the University of Colorado College of Nursing, co-authored a study published in Applied Clinical Informatics that qualitatively examined clinician fatigue in pediatric emergency departments. The research underscores the critical need for fatigue prevention strategies, organizational redesign initiatives, and structured break programs to protect both clinician well-being and patient safety.
Breaking Down the Study
During the study, interviews were conducted at an urban pediatric emergency department. The location chosen for the study receives 72,000 visits per year and serves as a level I regional pediatric trauma center for a seven-state area. Over the course of 17 months, 30 physicians and advanced practice providers at this location participated in interviews to help researchers identify the causes and effects of fatigue in the emergency department.
The Study Results
The study showed that fatigue affects decision-making in emergency department care, the use of clinical decision support (CDS) systems—technology tools that help clinicians make faster, more accurate diagnoses and treatment decisions—and a clinician's productivity and outcomes. Fatigue also affects a clinician’s ability to communicate with both patients and their families, and with their colleagues.
During the interviews, clinicians identified a variety of causes of fatigue, including high clinical volume, no access to clinical decision support systems (CDS), frustration using CDS systems, problems with patient workflow, spending hours in meetings before heading into an overnight shift, and a lack of breaks during a shift.
How Clinical Decision Support (CDS) Systems Help Physicians
Clinical decision support (CDS) is healthcare technology that provides clinicians, staff, patients, and other individuals with knowledge and person-specific information to enhance healthcare. Some examples include emergency department triage systems and diagnostic tools that assist healthcare providers in identifying less common conditions faster than traditional methods.
CDS systems can help clinicians make better, quicker decisions when they are experiencing fatigue at work. A CDS system can optimize treatment planning and drug management to enhance patient care efficiency and safety by analyzing a patient’s data, then suggesting medication and dosage. A CDS system can also enhance documentation and record keeping by suggesting diagnostic tests, flagging inconsistencies, and ensuring standardized documentation across providers. Proper training on how to use CDS systems can help reduce fatigue and assist clinicians with decision-making when fatigue impacts their ability to make quick decisions.
Looking Ahead to Prevent Burnout
Studies show that fatigue leads to burnout. Ozkaynak’s study found that fatigue in the pediatric emergency department was higher during high clinical volume times, such as respiratory season in the winter.
Respiratory issues are a common reason for pediatric ED visits, with approximately 9.6 million visits in 2022 during the respiratory illness surge, according to a publication on emergency department care for children in JAMA Network. Since this is an area of concern, additional research should be conducted to find effective ways to mitigate fatigue during the winter months in preparation for respiratory season.
Fatigue Comes with a Job in the Emergency Department
The publication concludes that while fatigue is an inherent part of the clinician's role in the emergency department, factors including changes in shift schedules, demands at work, and organizational inefficiencies can contribute to clinician fatigue.
Additional research should be conducted to evaluate ways to mitigate fatigue to ensure that patients visiting an emergency department receive the best care possible.
