title: Factors affecting stress in emergency medicine residents while working in the ED.
abstract: OBJECTIVE
  The aim of this study was to identify factors other than work hours in the emergency department (ED) work environment contributing to resident stress.
  
  
  METHODS
  This study involved a prospective cohort evaluation of emergency medicine residents in the ED. Twelve surveys were collected from 18 subjects, 4 each from the day, evening, and night shifts. The Perceived Stress Questionnaire and a visual analog stress scale were administered. Data collected included the shift number of a given consecutive sequence of shifts, number of procedures performed, number of adverse events, average age of the patients seen by the resident, triage nurse-assigned acuities of the patients seen by the resident during the shift, the number of patients seen during a shift, the number of patients admitted by the resident during the shift, anticipated overtime after a shift, and shift-specific metrics related to overcrowding, including average waiting room time both for the individual residents and for all patients, average waiting room count for all patients, and average occupancy of the ED for all patients.
  
  
  RESULTS
  Among the 216 studied shifts, there was considerable variability in stress both within and between residents. In the multivariate mixed-effect regression analysis, only anticipated overtime and process failures were correlated with stress. Factors related to ED overcrowding had no significant effect on resident stress.
  
  
  CONCLUSIONS
  Resident stress was most impacted by anticipation of overtime and adverse events. Overcrowding in the ED and traditional measures of workload did not seem to affect stress as much.
authors.affiliation: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-4700, USA. keith.wrenn@vanderbilt.edu
authors.forename: Keith
authors.initials: K
authors.lastname: Wrenn
authors.forename: Brent
authors.initials: B
authors.lastname: Lorenzen
authors.forename: Ian
authors.initials: I
authors.lastname: Jones
authors.forename: Chuan
authors.initials: C
authors.lastname: Zhou
authors.forename: Dominik
authors.initials: D
authors.lastname: Aronsky
mesh_terms: D000328:Adult; D004635:Emergency Medicine / Q000193:education; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency; D010561:Personnel Staffing and Scheduling; D011446:Prospective Studies; D013315:Stress, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D000078329:Workforce; D016526:Workload