Eligible EM resident physicians and emergency nurses included those providing 20 or more hours of patient care per week, having regular access to a smartphone, and providing consent to where a wrist-worn wearable device (WHOOP band [31]). Participants were recruited via email, completed informed consent, and were given a wrist-worn wearable device. Consenting participants completed a baseline survey assessing burnout and mental health (depression and anxiety), asked about their expectations of the study, and followed for 6 weeks. Validated instruments included the Patient Health Questionnaire (PHQ-8), General Anxiety Disorder (GAD-7), and the Professional Fulfillment Index (PFI) [32-36]. Over the 6 weeks, patients were also given access to a web-based platform that allowed participants to see their own physiologic data, access basic coaching videos, and connect to other users on the platform (Arena Strive [37]). At the completion of 6 weeks, participants were asked to complete a final survey exploring the feasibility and acceptability of the approach. Participants were also asked to provide free text commentary on the general approach and the specific device. The primary outcomes were use of the wearable device, acceptance of the device, and adoption of the device. Secondary measures included burnout, mental health symptoms, and physiologic measures recorded by the device including HRV and sleep.

This was a longitudinal pilot feasibility study conducted at an urban, academic, level 1 trauma center in the northeastern United States. This study was reviewed and approved by the University of Pennsylvania Institutional Review Board (850371). All eligible participants completed informed consent forms and were informed that all data would be deidentified and aggregated for analysis. Participants received the wearable device at no cost and could keep the device following the completion of the study.

Analysis was conducted using Stata SE (version 18; StataCorp). Descriptive statistics were used to summarize participant demographics and well-being survey results which included the PHQ-8, GAD-7, and the PFI. Single-sample 2-tailed t tests were used to investigate exploratory differences in physiologic measures.

The physical and mental toll facing clinicians working in the ED continues to grow. Emergency nurses and resident physicians face a number of challenges impacting their health including, but not limited to, ED crowding, boarding, workplace violence, shifting schedules, and rising patient acuity. In the wake of the COVID-19 pandemic, an emphasis on supporting the workforce remains a priority. The evolving landscape of digital technology, including wearable devices, offers new opportunities for individuals to monitor their own health and potentially proactively identify physical or mental strain. This pilot study begins to examine if and how wearable devices can be used for emergency clinicians.

First, we found mixed enthusiasm for this approach given low interest in completing exit surveys and ongoing data interaction. It appears from this early feasibility study that resident physicians may be more engaged with this strategy and data collection method. Nurses in this pilot tended to be less engaged with the data tracking and follow-up mechanisms. Resident physicians were, in general, more enthusiastic before, during, and after the period ended. Though small in size, this pilot study does shed some initial interest from emergency clinicians and understanding key physiologic metrics such as sleep and physical activity. Key data insights remain physical activity as measured by step count, amount and quality of sleep, and HRV, which is an established physiologic measure relating to CV health [38]. The next steps to build on this pilot study included bringing it to a larger scale and designing it for nurse and physician preferences which we have learned to date.

The key finding of this pilot study is that the type of device and platform must be optimized for clinician use. In this study, we used a high-performance athletics device, which is designed primarily for physiologic measures [39]. This device does not have some traditional features that the average person may be accustomed to including a clock and the ability to send or receive messages. More traditional and popular bands such as the Apple Watch or Fitbit offer participants data tracking with features such as message-sending capability and a watch. These features are important when designing for scale, but were not previously known until we pilot-tested it, as other studies in more controlled environments have used the same device [39,40], underscoring the need to optimize design over technological capacity. The high-performance athletic band used in this pilot study offered a longer battery life and the ability to charge while wearing the device, which seemed less important to participants in this study. Future work needs to leverage the existing devices that clinicians wear in their everyday lives and incorporate those devices into this approach.

Finally, these devices and remote surveys highlight the persistent and real variation in professional disengagement, exhaustion, and burnout. In this small cohort, we do not identify significant amounts of anxiety or depression in screening assessments. We do note some variation and physiologic measures across resin physicians and nurses as well as differences across individuals who identify as male vs female. These differences though statistically significant, represent only a small sample size, and follow-up studies need to be scaled at larger populations. Specific interests should investigate physiologic measures such as heart rate, HRV, and sleep.

This study has several limitations. This was a single-center pilot study and had a small sample size, which was intentional by design. We see glimpses toward mechanisms to optimize digital technology and workforce sustainment. The signals identified here represent only early pilot findings, and inherently there is also selection bias in individuals who opted to wear the band and complete surveys. Less is known about individuals who do not want to be part of this pilot, and future studies will need to be larger, randomized, and for a longer duration. Nonetheless, the study is among the first to begin to investigate the feasibility of using digital technology to support emergency physicians and nurses by helping them identify physiologic variations in their own health. The study represents the pilot beginnings to help identify proactive and much-needed new methods to mitigate strain that is related to physical and mental health.

This pilot study of emergency nurses and resident physicians investigating wearable devices to capture physiologic data from a cohort represents early signals toward feasible and acceptable programs. This pilot study identifies opportunities and interest in these mechanisms and a need to leverage more consumer-facing and potentially less sophisticated wearable devices for emergency clinicians. These methods can be further explored and larger, randomized trials can be conducted to investigate these strategies and how we support the workforce.