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Slamon, Nicholas; Penfil, Scott; Deutsch, Ellen; Nadkarni, Vinay

doi: 10.1097/01.ccm.0000509806.93957.c4
Research Snapshot Theater: Quality and Safety VIII

Learning Objectives: ICU physician stress is a target of research in critical care to limit errors and burnout, with a need for monitoring and mitigation strategies. Physiologic assessment usually requires simulation. m-Health (mobile health) technologies developed for athletics, military and aerospace industries allow high fidelity real time biometric measurements. We hypothesized the ability to measure and analyze physician stress during live ICU activities

Methods: Prospective, observational study of an attending physician wearing a biometric smart shirt (Hexoskin™) during ICU shifts from February to June 2016. Continuous measures included heart rate (HR), respiratory rate (RR), minute ventilation (MV), cadence, energy expenditure and sleep parameters. ICU activities included patient rounds (RND), Tracheal Intubation (TI), a family meeting (MTG) and a code blue activation (CB). A 12 minute treadmill test was a control for physiologic stress. Paired t test and SD testing of equal variances were performed on HR, RR, and MV. Fast Fourier transform (FFT) algorithm was used to evaluate HR variability.

Results: The garment was worn without complication for 28.05 hours. ICU events were abstracted using biometric data points (time): RND n=12,236 (3.38 hours), TI n=983 (16.76min), MTG n=287 (8.12min), and CB n=886 (16.38min). The most stressful activity was TI, 147 beats per minute (HR) and 52 breaths per min (RR) (mean 115/24). MTG was least stressful, HR/RR maxiumum reached 93/36 (mean 80/12). Paired t test with equal variances was performed with statistical significance (p<0.001). SD testing of equal variances and FFT of HR was also significant (p<0.001) when comparing TI and CB, confirming TI the more stressful activity.

Conclusions: This is the first study to capture the biometrics of a critical care physician during stressful live ICU activities. Variable stress patterns were characterized from most to least stressful as TI, CB, RND, and MTG. Future research directions include measuring stress across various staff experience levels, prospectively testing stress reduction techniques and coaching.

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