How accurate are weight measurements for burn patients in A&E departments. Why is precise weight assessment important for fluid resuscitation in severe burns. What methods are used to weigh burn patients in emergency settings.

The Importance of Accurate Weight Measurement in Burn Resuscitation

Proper fluid resuscitation is critical for improving survival outcomes in patients with severe burns. While much emphasis has been placed on accurately calculating the percentage of total body surface area (TBSA) burned, less attention has been given to obtaining a precise patient weight measurement. This oversight can potentially compromise the effectiveness of fluid resuscitation protocols.

Resuscitation formulas like the Parkland formula rely on both TBSA burned and patient weight to determine initial fluid requirements. However, a study examining weight assessment practices in accident and emergency (A&E) departments found concerning discrepancies between estimated weights and actual measured weights of burn patients upon arrival at burn centers.

Study Findings on Weight Measurement Accuracy

The study reviewed 42 cases of patients with burns requiring resuscitation. Key findings include:

• In 32 cases where an A&E weight was documented, half had a difference of over 5 kg compared to the measured weight at the burn center
• 9 patients had weight differences exceeding 10 kg
• Only 3 out of 16 surveyed A&E departments had sit-on scales for weighing patients unable to stand
• Most A&E units relied on stand-on scales or estimates for non-ambulatory patients

These results highlight significant inaccuracies in weight assessment that could lead to under or over-resuscitation of burn patients.

Impact of Weight Inaccuracies on Fluid Resuscitation

How do weight measurement errors affect fluid resuscitation calculations? Let’s consider an example:

For a 70 kg adult with 40% TBSA burns, the Parkland formula would recommend:

• 4 ml x 70 kg x 40% TBSA = 11,200 ml of fluid in the first 24 hours

If the patient’s weight was overestimated by 10 kg:

• 4 ml x 80 kg x 40% TBSA = 12,800 ml

This 1,600 ml difference could potentially lead to fluid overload and associated complications. Conversely, underestimating weight could result in inadequate fluid resuscitation.

Current Methods of Weight Assessment in A&E

The study surveyed 16 A&E departments to evaluate their weight assessment capabilities. The findings revealed:

• Most departments only had stand-on scales
• Only 3 departments had sit-on scales
• For non-ambulatory patients, staff often relied on:
  • Asking patients or relatives
  • Estimating based on appearance
  • Guessing

These methods introduce significant potential for error, especially in emergency situations involving severely burned patients who may be unable to stand or communicate effectively.

Improving Weight Assessment in Emergency Settings

To enhance the accuracy of fluid resuscitation calculations, A&E departments should consider implementing the following measures:

1. Invest in appropriate weighing equipment, including:
   • Bed scales
   • Hoist scales for non-ambulatory patients
   • Wheelchair scales
2. Develop protocols for weighing all burn patients requiring fluid resuscitation
3. Train staff on the importance of accurate weight measurement and proper use of weighing equipment
4. Implement quality control measures to ensure regular calibration of scales
5. Consider using bioelectrical impedance analysis devices for rapid weight estimation when direct measurement is not possible

The Role of Technology in Burn Assessment

Advancements in technology are offering new solutions for burn assessment, including weight estimation. Some innovative approaches include:

3D Scanning and Imaging

Three-dimensional scanning technology can create detailed body models, potentially allowing for more accurate estimation of both TBSA burned and patient weight. While not yet widely implemented in emergency settings, this technology shows promise for improving burn assessment accuracy.

Smartphone Apps for TBSA Calculation

Several smartphone applications have been developed to assist in calculating TBSA burned. While these tools can improve the accuracy of burn size estimation, they do not address the issue of weight measurement. However, future iterations could potentially incorporate weight estimation features based on body measurements or image analysis.

The Importance of Continuous Monitoring and Adjustment

While accurate initial weight measurement is crucial, it’s important to remember that fluid resuscitation formulas provide only a starting point. Continuous monitoring of patient response and adjustment of fluid administration is essential for optimal outcomes.

Key parameters to monitor include:

• Urine output
• Blood pressure
• Heart rate
• Serum lactate levels
• Central venous pressure (in severe cases)

Fluid administration should be titrated based on these clinical indicators, regardless of the initial calculated volume.

Challenges in Pediatric Burn Resuscitation

Accurate weight assessment is particularly crucial in pediatric burn patients, where even small discrepancies can have significant impacts on fluid calculations. Challenges in pediatric weight assessment include:

• Rapid growth and weight changes in children
• Difficulty in obtaining cooperation for direct measurement
• Variations in body composition compared to adults

To address these challenges, pediatric-specific strategies should be employed:

1. Use of length-based weight estimation tools (e.g., Broselow tape) when direct measurement is not possible
2. Regular staff training on pediatric weight estimation techniques
3. Implementation of pediatric-specific weighing equipment in A&E departments

Future Directions in Burn Resuscitation Research

As our understanding of burn physiology and fluid dynamics continues to evolve, future research directions may include:

• Development of more personalized resuscitation protocols based on individual patient characteristics
• Investigation of novel biomarkers for guiding fluid resuscitation
• Exploration of alternative resuscitation fluids and strategies
• Integration of artificial intelligence and machine learning for optimizing fluid management

These advancements may reduce the reliance on rigid formulas and allow for more nuanced and effective resuscitation strategies. However, accurate weight measurement is likely to remain a fundamental component of burn care.

The Economic Impact of Improved Weight Assessment

Investing in better weighing equipment and protocols may have significant economic benefits for healthcare systems. Consider the potential costs associated with inaccurate fluid resuscitation:

• Prolonged hospital stays due to complications
• Increased risk of organ dysfunction requiring intensive care
• Additional interventions to manage fluid overload or under-resuscitation

By contrast, the one-time cost of implementing improved weighing systems could lead to:

• Reduced complication rates
• Shorter hospital stays
• Improved patient outcomes
• Decreased overall healthcare costs associated with burn treatment

A cost-benefit analysis considering these factors could provide a compelling argument for healthcare administrators to prioritize investments in accurate weight assessment capabilities.

Case Study: Implementation of a Comprehensive Weighing Protocol

To illustrate the potential impact of improved weight assessment, consider the following hypothetical case study:

A large urban hospital implemented a comprehensive weighing protocol for burn patients in their A&E department, including:

• Installation of bed scales and hoist scales
• Staff training on proper weighing techniques
• Integration of weight measurement into the electronic health record system
• Regular audits of weight measurement accuracy

After one year of implementation, the hospital observed:

• A 30% reduction in fluid-related complications in major burn cases
• An average decrease of 2 days in length of stay for patients with burns >20% TBSA
• Improved staff confidence in managing burn resuscitation
• Estimated cost savings of $500,000 due to reduced complications and shorter hospital stays

While this case study is hypothetical, it demonstrates the potential benefits of prioritizing accurate weight assessment in burn care.

Ethical Considerations in Weight Assessment

As healthcare providers strive to improve weight assessment accuracy, it’s important to consider the ethical implications of these practices. Some key considerations include:

Patient Dignity and Privacy

Weighing severely burned patients may require exposing them or placing them in potentially uncomfortable positions. Healthcare providers must balance the need for accurate measurements with maintaining patient dignity and privacy.

Informed Consent

In emergency situations, obtaining informed consent for weighing may not always be possible. Protocols should be in place to address this issue and ensure that patients or their representatives are informed about the importance of weight measurement in their care.

Data Protection

With the increasing use of electronic health records and potential integration of weight data into these systems, ensuring the security and privacy of this information is crucial.

Equitable Access to Care

As more advanced weighing technologies become available, there’s a risk of creating disparities in care between facilities with access to these resources and those without. Efforts should be made to ensure that all burn patients have access to accurate weight assessment, regardless of the treating facility’s resources.

Addressing these ethical considerations will be crucial as healthcare systems work to improve weight assessment practices in burn care.

The Role of Professional Organizations and Guidelines

Professional organizations play a crucial role in setting standards and disseminating best practices in burn care. How can these organizations contribute to improving weight assessment in burn resuscitation?

• Developing and updating guidelines that emphasize the importance of accurate weight measurement
• Incorporating weight assessment techniques into burn care certification programs
• Funding research on innovative weight estimation methods
• Advocating for the inclusion of appropriate weighing equipment in A&E department standards
• Collaborating with emergency medicine organizations to improve burn care practices across specialties

By taking a proactive approach, these organizations can drive systemic improvements in weight assessment practices for burn patients.

Example: American Burn Association Initiatives

The American Burn Association (ABA) has recognized the importance of accurate fluid resuscitation in burn care. While not specifically focused on weight assessment, their initiatives demonstrate how professional organizations can influence practice:

• Publishing guidelines on fluid resuscitation practices
• Offering educational programs on burn management, including fluid resuscitation techniques
• Supporting research on optimizing burn resuscitation strategies
• Collaborating with other organizations to improve emergency burn care

Similar efforts focused on weight assessment could significantly impact patient care and outcomes.

Integrating Weight Assessment into Burn Center Referral Protocols

Improving weight assessment practices not only benefits initial resuscitation efforts but can also enhance the continuity of care as patients are transferred to specialized burn centers. How can weight assessment be better integrated into burn center referral protocols?

• Developing standardized weight reporting forms for referring hospitals
• Implementing telemedicine consultations that include guidance on proper weight assessment
• Creating feedback mechanisms for burn centers to report discrepancies in reported vs. measured weights
• Establishing regional networks to standardize weight assessment practices across referring hospitals

By improving communication and standardization of weight assessment practices between referring hospitals and burn centers, patients can receive more consistent and accurate care throughout their treatment journey.

Case Example: Regional Burn Network Initiative

A hypothetical regional burn network implemented a standardized weight assessment protocol across all referring hospitals and the central burn center. The protocol included:

• Provision of consistent weighing equipment to all network hospitals
• Standardized training for emergency department staff
• A dedicated section for weight measurement in the burn transfer form
• Regular audits and feedback sessions to improve accuracy

After implementation, the network observed:

• A 50% reduction in weight discrepancies >5 kg between referring hospitals and the burn center
• Improved consistency in initial fluid resuscitation practices
• Enhanced communication between referring hospitals and the burn center
• Increased confidence among referring hospitals in managing the initial phases of major burn cases

This example illustrates how a systematic approach to weight assessment can improve care coordination and patient outcomes across a regional burn care network.

The Global Perspective: Weight Assessment in Resource-Limited Settings

While the focus of this discussion has been on improving weight assessment in well-equipped healthcare systems, it’s important to consider the challenges faced in resource-limited settings. How can accurate weight assessment be achieved in areas with limited access to advanced medical equipment?

Innovative Low-Cost Solutions

Several approaches have been developed to address weight assessment challenges in resource-limited settings:

• Hanging scales: Simple, portable, and can be used for non-ambulatory patients
• Sling scales: Adaptable for various patient positions and sizes
• Locally-made bed scales: Constructed using available materials and calibrated against known weights
• Visual estimation tools: Charts correlating visual appearance with estimated weight ranges

Training and Education

In settings where advanced equipment is not available, focusing on training healthcare providers in weight estimation techniques becomes crucial. This can include:

• Visual estimation practice using volunteers of known weights
• Techniques for estimating weight based on arm circumference or height
• Regular calibration exercises to improve estimation accuracy

Telemedicine Support

Where possible, telemedicine connections with better-equipped facilities can provide support in weight estimation and fluid resuscitation calculations. This approach can help bridge the gap between resource-limited settings and more advanced burn care centers.

By addressing the challenges of weight assessment in diverse healthcare settings, the global burn care community can work towards more equitable and effective treatment for all burn patients, regardless of geographic or economic constraints.

So much for percentage, but what about the weight?

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So much for percentage, but what about the weight?

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1. T C S Cubison1,
2. P M Gilbert2

1. ¹Specialist Registrar in Plastic Surgery
2. ²Consultant Plastic Surgeon and Director of the McIndoe Burn Centre, Queen Victoria Hospital, East Grinstead, UK

1. Correspondence to:
 Tania Cubison
 Slipmill Hollow, Hawkhurst, Kent TN18 5AB; tania.cubisonlineone.net

Abstract

The use of resuscitation formulae for burns is advocated for A&E departments. Much care is taken to calculate the percentage of the burn, but this is then multiplied by an approximate weight. How accurate is this figure and should it be more carefully measured?

Forty two sets of case notes of patients with resuscitation sized burns were reviewed. In 32, a weight was documented in the A&E notes. This was compared with the measured weight on arrival at the burn centre. In half the cases there was a greater than 5 kg difference and in nine patients over 10 kg of difference.

The methods of patient weight assessment in 16 A&E departments were reviewed. The majority have only stand on scales. Three departments have sit on scales; however, if they were assessing the weight of a patient who is unable to sit they would need to ask the patient, relatives, or simply guess.

Investment in weighing equipment should be encouraged if resuscitation formulae are to have any place in the A&E management of burn patients.

• A&E, accident and emergency
• ATLS, Advanced Trauma Life Support
• EMSB, Emergency Management of Severe Burns
• TBSA, total percentage body surface area

• burns
• resuscitation
• weight assessment

http://dx. doi.org/10.1136/emj.2003.011304

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• A&E, accident and emergency
• ATLS, Advanced Trauma Life Support
• EMSB, Emergency Management of Severe Burns
• TBSA, total percentage body surface area

• burns
• resuscitation
• weight assessment

The understanding of the need for intravenous fluid resuscitation and the adoption of resuscitation regimes is one of the significant issues that has improved the mortality of major burns over the last 50 years.^1–3

Formulae have been established for crystalloid and colloid resuscitation, and the volumes suggested reflect the different properties of these fluids. The most common combinations are the Parkland formula for crystalloid resuscitation with Hartmanns solution and the Muir and Barclay formula for colloid resuscitation.^4,5 The Muir and Barclay formula was originally described using plasma and is usually modified to reflect the fact that in current practice human albumin solution is used.

The resuscitation formulae provide a guideline for the commencement of intravenous fluid resuscitation, the effect of the regimen is judged by clinical indicators such as urine output, and patients must be continuously monitored then the actual volumes delivered adjusted accordingly.

The initial resuscitation plan is commenced in the referring accident and emergency department (A&E) prior to the transfer of the patient to the burn centre and the use of formulae is therefore strongly recommended. The use of the Parkland formula and Hartmanns resuscitation is taught both by Emergency Management of Severe Burns (EMSB) and Advanced Trauma Life Support (ATLS) programmes. ^6,7

The main components of both formulae are the patient’s total percentage body surface area burnt (%TBSA) and their weight in kilograms. The %TBSA can be assessed clinically using Lund and Browder burns charts⁸ or Wallace’s rule of nines.

There has been considerable interest from the burns fraternity to educate A&E staff in the rather subjective art of percentage assessment as a method of improving the accuracy of fluid resuscitation calculations. The weight measurement appears not to have been equally scrutinised.

Our hypothesis is that the assessment of weight of patients with burns in A&E is an objective measurement.

OBJECTIVE

A study was undertaken to consider weight assessment by A&E units. The aims were to establish the methods of weight assessment and to review the accuracy of this assessment in some resuscitation sized burns.

MATERIALS AND METHODS

The case notes of 42 patients who had sustained burns over 15%TBSA in adults and 10%TBSA in children were obtained and their A&E documentation reviewed. The A&E weight was noted when available and this was compared with the weight assessed at the burn centre. The A&E weight was subtracted from the burn centre weight and a difference in kilograms obtained

The burn centre weight is assessed using a weighbridge. On arrival the patient and trolley are weighed, and after the patient is transferred the trolley and all equipment are weighed again so that a fairly accurate subtraction weight is established.

Subsequently, all 16 local A&E units were contacted by telephone and the staff were questioned:

1. How do you routinely weigh patients?

2. Do you have any way of weighing a patient unable to stand?

3. How do you assess the weight of a patient in your resuscitation room?

RESULTS

Forty two sets of case notes were obtained and 32 contained A&E assessment of weight. The average age was 46 years (range 13–91) with only one paediatric patient. The average TBSA burnt was 37% (range 15–86%).

In half of the patients there was a difference of over 5 kg between the A&E weight and that of the burn centre, and in nine patients the difference was over 10 kg (fig 1).

Figure 1

 Individual patients’ weights. BU wt should be Burn centre Weight in kg; AE wt is A&E weight in kg; Difference is the difference between the Burn centre weight and A&E weight.

In the telephone survey the 16 units questioned all routinely used a stand-on scale for adults. Three units had access to a sit on scale (not always in A&E). No unit had an objective method of assessing patients in the resuscitation room (table 1). The normal practice is to ask the patient or relatives how much they weigh or simply to make a guess.

Table 1

 Weighing equipment in accident and emergency departments

DISCUSSION

It is clear from this study that the assessment of weight in A&E is not an objective measurement. The weights given are usually an underestimation, perhaps reflecting an underlying wish to be lighter than we actually are. It is true that intravenous fluid resuscitation will be under way in transit and that the weight will increase by 1 kg per litre of fluid given; however, this does not account for discrepancies of over 5 kg.

The practical implication of weight assessment needs to be considered in the context of a resuscitation formula and the maximum Parkland crystalloid formula of 4 mls/kg/%TBSA is used here.

To demonstrate the significance of a 10 kg weight discrepancy fig 2 plots increasing %TBSA against calculated 24 hour fluid requirement, with columns representing increasing body mass within each %TBSA.

Figure 2

 The influence of patient weight on Parkland Resuscitation volumes.

This demonstrates that with increasing percentage burn a 10 kg weight discrepancy has more effect on the calculated volume. This is simplified in fig 3 where a standard 10 kg weight difference is shown with %TBSA plotted against volume. The volume discrepancy can now be visualised more easily—for example, in a 75% burn, 10 kg of weight represents 3 litres of fluid over 24 hours.

Figure 3

 The influence of 10 kg weight estimation error. If the TSBA is 50%, a 10 kg weight under estimation error would result in 2 litres less fluid calculated in the 24 hours resuscitation period.

The overall relevance must also consider the total weight of the patient for 10 kg is 12.5% of an 80 kg patient but 20% of a 50 kg patient. The lighter the patient the greater need for accuracy.

Actual fluid volumes transfused were assessed; however, this figure does not simply reflect the patient weight estimation. The A&E fluid calculation is based on their assessment of percentage (often different to the burn centre), and a delay from the time of injury may require a catch up period. The total volume transfused before reaching the burn centre also reflects the transfer time. These actual volumes were therefore not included but the following simplified calculations demonstrate the potential volumes involved.

In fig 4, the actual patient data for weight are used. To assess the impact of the weight discrepancy, the fluid requirements for each patient have been be calculated using the %TBSA as assessed by the burn centre and the A&E weight, which is then repeated using the burn centre percentage and burn centre weight and the two volumes compared.

Figure 4

 Calculated difference in fluid requirements over 24 hours.

The upper part of the chart represents patients who were assessed to be lighter by the A&E and therefore prescribed insufficient fluid. These include a 77 year old patient who could have been under resuscitated by 4 litres. The lower part of the graph represents patients given more fluid than that required and these include a 81 year old patient given an extra 2 litres.

As previously mentioned, the formulae only provide a start point for resuscitation and should not be prescribed without adjustment for clinical assessments such as urine output; however, the formulae are effective when used carefully and this does include a good objective assessment of weight.

The measurement of weight can be achieved by the use of standard scales in a fit patient and the small %TBSA patient may be able to sit on a suitable scale. The weighing of a recumbent patient does require more specialist equipment; however, this does not have to be of a prohibitively expensive nature. The options include a weigh bridge, specialist beds that contain integral weighing scales, and it is also possible to weigh the patient on the A&E trolley using a specialist scale that clips around the trolley wheels.

The results from this study highlight the difficulty of weight assessment in the A&E departments and have implications for many different specialties. If the patients’ weight is documented inaccurately this may later be assumed to be an objective measurement and errors may occur. The availability of inexpensive trolley scales should be highlighted to those responsible for equipping A&E departments as the problem of weight assessment inaccuracy is very easily solved.

REFERENCES

1. ↵

   Jackson DM. McIndoe lecture, 1978. Burns: McIndoe’s contribution and subsequent advances, Ann R Coll Surg Engl1979;61:335–40.

2. el Danaf A. Burn variables influencing survival: a study of 144 patients. Burns1995;21:517–20.

3. ↵

   Fratianne RB, Brandt CP. Improved survival of adults with extensive burns. J Burn Care Rehabil1997;18:347–51.

4. ↵

   Muir IKF, Barclay TL. Burns and their treatment. London: Lloyd Luke Ltd, 1974.

5. ↵

   Baxter CR. Fluid volume and electrolyte changes of the early postburn period. Clin Plast Surg1974;1:693–703.

6. ↵

   British Burn Association. Emergency Management of Severe Burns UK Course Manual, 1996.

7. ↵

   Committee on Trauma American College of Surgeons. Advanced Trauma Life Support Course1989.

8. ↵

   Lund CC, Browder NC. Estimation of areas of burns. Surg Gyn Obst1944;79:352–8.

Footnotes

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What It Is, 2 Types, Formula, and Examples

What Is Burn Rate?

The burn rate represents the speed at which an unprofitable company consumes its cash reserves. In the case of a startup company, it is the rate at which a new company is spending its venture capital to finance overhead before generating positive cash flow from operations. Thus, it is a measure of negative cash flow.

Burn rate is most often a consideration for young life sciences or technology companies without profits and, in some cases, without revenue. It is usually quoted in terms of cash spent per month. For example, if a company is said to have a burn rate of $1 million, it would mean that the company is spending $1 million per month.

Key Takeaways

• The burn rate is the pace at which a new company not yet generating profits consumes its cash reserves.
• The burn rate is typically calculated in terms of the amount of cash that the company is spending per month.
• Gross burn is the total amount of operating costs that a company racks up each month, while net burn is the total amount of money that a company loses monthly.
• The burn rate affects a company’s financial “runway,” which is how long the company has before its operating capital is exhausted; a higher rate means a shorter runway.

Burn Rate

Understanding the Burn Rate

The burn rate is used by startup companies and investors to track the amount of monthly cash that a company spends before it starts generating its own income. A company’s burn rate is also used as a measuring stick for what is termed its “runway”—the amount of time that the company has before it runs out of money.

If a company has $1 million in the bank and spends $100,000 a month, its runway would be 10 months, derived as:

Total Capital ÷ Monthly Operating Expenses = Runway

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In this case, that would be:

$1,000,000 ÷ $100,000 = 10 months

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A company can reduce its gross burn rate by producing revenue and/or cutting costs, such as reducing staff or seeking cheaper means of production.

How to Calculate the Burn Rate

There are two types of burn rates: net burn and gross burn. A company’s gross burn rate is simply the total amount of operating costs that it incurs in expenses each month, expressed as:

Total Monthly Operating Costs = Gross Burn Rate

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A company’s net burn rate, however, is the total amount of money that a company loses each month. This can’t be greater than the gross burn rate, but it can be less.

For example, if a technology startup spends $5,000 monthly on office space, $10,000 on monthly server costs, and $15,000 on salaries and wages for its engineers, its gross burn rate would be $30,000. However, if the company is also producing revenue, its net burn rate would be different, calculated as follows:

(Monthly Revenue - Cost of Goods Sold) - Gross Burn Rate = Net Burn Rate

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Let’s say that the above company with a gross burn rate of $30,000 also has revenues of $20,000 a month from selling goods, and let’s put the costs of those goods to the company at $10,000 a month. The company’s net burn rate would be $20,000, derived as:

($20,000 - $10,000) - $30,000 = -$20,000

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Even if the company is spending $30,000 every month, the actual amount it is losing per month is only $20,000. This is an important distinction, because it alters the financial runway. If the company had $100,000 in the bank, its runway would be five months rather than three months. The longer stretch of time will affect both how the managers outline the company’s strategy and the amount of money that an investor might be willing to put into the company.

If the burn rate begins to exceed its forecast, or if revenue fails to meet expectations, the usual recourse is to reduce the burn rate, regardless of how much money is in the bank. This requires rethinking the startup’s cost structure and usually means reducing staff and/or other major cost drivers, such as office lease, technology, and marketing.

What is a good burn rate?

The general recommendation is for a startup business to have six to 12 months of expenses on hand. If the company has $100,000 in the bank, a good burn rate would fall between $16,667 (six months) and $8,333 (12 months).

How do you calculate the burn rate?

There are two kinds of burn rates: gross and net. The gross burn rate is simply the total amount of money spent each month. The net burn rate is the amount of money lost each month and takes into account any possible company revenue. It is calculated using the following formula: (Monthly Revenue – Cost of Goods Sold) – Gross Burn Rate = Net Burn Rate.

Is burn rate the same as expenses?

Yes, if you are calculating the gross burn rate. However, if you want the net burn rate, you must also factor in whatever revenue the company may be generating.

The Bottom Line

The burn rate is an important metric for any company, but it is particularly important for startups that are not yet generating any revenue. It tells managers and investors how fast the company is spending its capital. The burn rate is used to pinpoint when a company will begin going into debt, expressed as the company’s financial runway. If a burn rate is too high, a company has no choice but to lower its structural costs by reducing what it is spending on staff, housing, marketing, and/or technology.

how to recognize it, neutralize it and turn it to your advantage / Sudo Null IT News

If you are already sick of work, is it necessary, gritting your teeth, to motivate yourself for new achievements, or is this a reason to sound the alarm? I’ll tell you about how professional burnout once brought me to depression, how to recognize it in a timely manner and prevent it from ruining your career.

Nausea from work

Ten years ago I worked as a chief accountant, but I hated my job. Sleep was the best time. I woke up happy and my mood started counting down to zero. Ten, nine – took a shower, had breakfast – eight, seven – left the house – six – got into the car – five, four, three – drove to work – two – went to the office – one , – entered the accounting department, – zero. He turned the switch, and the fluorescent lamps twitched nervously under the ceiling – start. Hello my new depressing day.

All day long I was walking like a zombie, idling on the computer, drinking endless tea and participating in all the meetings, conversations and discussions just to do nothing. The work did not fail just because everything was delegated, and when it came time to do the reporting, I collected myself piece by piece and handed over this reporting. Needless to say, I hated myself, accounting and even the color of the wallpaper in the accounting department. The burnout turned out to be so strong that, after swimming for several months in depression, I dropped everything and left for another city.

However, I got off lightly. Alena Vladimirskaya during the pandemic wrote a post about how her friend shot himself due to burnout.

This also happens. But even if you do not take into account the extremes, many people have enough stress in their daily work, so if you feel like you are on the edge, this is an occasion to sound the alarm.

Professional burnout and its signs

Professional burnout is also called emotional burnout. In May 2019, professional burnout syndrome was included in the International Classification of Diseases (ICD 11). Burnout syndrome is not a disease, but a complex of factors that predispose to more serious conditions (severe stress, anxiety, depression).

The WHO defines burnout as a phenomenon caused by chronic stress at work and lists three key signs of burnout:

1. feelings of motivational or physical exhaustion;

2. mental distancing from professional duties, feeling of negativity or cynicism towards professional duties;

3. performance degradation.

The picture is not very attractive. A person does not care about work, he is negatively or skeptical about any new task, he is of little use, he does not radiate enthusiasm. But it is important to understand that such behavior is logical. The body does not have the resources to run with the flag, it fights for its own survival, and everything that eats energy gets under the knife. First of all, work. And until the forces are restored, nothing will change.

Causes of emotional burnout

Stress, which leads to emotional burnout, is dangerous because, as a rule, it accumulates gradually and imperceptibly. There is no single event that leads to burnout, it is always a series of microtraumas:

• I took a couple of extra tasks, what will happen to a couple of tasks?

• Began to stay longer at work, because the project is so important.

• Relations with a colleague deteriorated, but you can’t raise children with him.

• A lot of routine, which is repeated from day to day, but others do something and do not squeak.

Every event is a trifle that you should not pay attention to, a tiny pebble that is easy to carry. But over the years of such pebbles, a whole backpack accumulates, and a person breaks under their weight. How to recognize dangerous symptoms in advance?

Life consists only of work

Someone works a lot because of objective necessity, someone was told that it is impossible otherwise, and someone is crazy about his work and therefore gives it every minute. Although work not only takes away, but also gives energy, workaholics run out of steam over a long distance. The tricky part is that it’s especially hard to notice for those who love their job for several reasons.

1. They enjoy their work, and with it a lot of goodies (demand on the labor market, good salary, career growth).

2. Obsession with work allows you to avoid other areas of life where the workaholic is not so good. For example, communicate less with loved ones, do not pay attention to your body and health, do not think: “Why do I live at all? Am I wasting my life on this?” In other words, workaholism is also a successful escape from problems in other areas of life, which is why it is so difficult to give up.

3. For energetic people, work is an excellent energy utiliser. Otherwise, they do not know where to put themselves.

Some people need months, and some years, for the batteries to run out and emotional exhaustion to overwhelm the person, but sooner or later it happens.

Uncertainty

The matter is exacerbated when the level of uncertainty is high. You don’t know if you made the right decisions or not. This applies to creative and managerial professions, where you have to move into the unknown by touch, and there are no clear criteria that would help assess whether you are doing everything right. The risk of burnout increases especially when not only the level of uncertainty is high, but also the cost of an error is high.

Thoughts that won’t let go

It often happens that at work we are too busy to worry, so stress catches up with us after work. You are driving home, but you keep thinking about work. Eating dinner but thinking about work. Go to bed, but think about work.

This cycling is called rumination (rumination is the rumination of cows as they burp and re-chew their food) and results in time that could have been spent resting being wasted in mental rumination and anxiety.

Pace too fast

Another cause of burnout is when a person takes too much pace and tries to run a marathon at sprint speed. For example, an entrepreneur starts a business and thinks: “I’ll work hard for a year, and then it will become easier.” But it doesn’t get easier. And then there is a feeling that you are swimming with all your might, and the shore is being pushed back and pushed back.

Or here it is, but something didn’t get any easier

If you live on an aortic rupture, then even a formally balanced life, in which there is not only work, but also a place for hobbies, friends, family, and sports, does not save. The problem is that it is difficult for people for whom achievement is important to calculate the pace that is feasible for themselves. Often they evaluate their capabilities at the peak of productivity and extrapolate this assessment for a lifetime. As a result, they pile on too much, which gradually leads them to emotional exhaustion.

The company environment is toxic

The question to ask yourself is: how comfortable is the atmosphere in the company? Would you volunteer to spend extra time with these people? How valued and respected are you? How many negative feelings: guilt, anger, resentment, shame, fear, anxiety are born in you about work?

Emotions are a good indicator of what’s going on with you and how comfortable your work environment is. If you regularly see your boundaries being violated and your needs ignored, get out of there. You are alone.

Unable to influence the outcome

The feeling that nothing depends on you and you do not influence anything quickly leads to burnout and depression. It can cover both ordinary performers who are forced to fulfill other people’s Wishlist, and entrepreneurs who spin like a squirrel in a wheel, but do not achieve the desired results. Vain efforts give rise to a feeling of helplessness, from which hands drop: “Why try if nothing depends on me?”

Alien role

Psychologists’ mantra – “be yourself” – is useful for the prevention of professional burnout. If a gentle and kind person has to demonstrate toughness and inflexibility every day, he will quickly run out of strength. In the same way, a directive person will quickly get tired of playing the role of sweet and empathic.

Everything is meaningless and cruel

And, finally, the reason closest to me is that the work seems meaningless and boring. There is no drive in it, there is nothing interesting, it seems that if you stop doing what you are doing, no one will notice. Such thoughts often visited me when I worked as an accountant. For a while it was possible to force oneself, to artificially find at least some interest, but for a long time one could not deceive oneself, and aversion to work accumulated.

Stages of emotional burnout

What does the process of burnout look like if it is broken down into stages? I must say that for different people it looks different and strongly depends on the initial attitude to work and the ability to get involved in it, but 4 stages can be distinguished.

#1. Work norms (or super!)

There are two reasons to be wary.

The first, if the work causes you resistance. In general, it is normal, but every day you need to make an effort to do it. Often there is procrastination, thoughts come: “Am I in my place?” You feel that if you had the choice not to do it, you would not do it.

Second, if you are a fan of work and you want to devote every minute to it. This is reminiscent of the manic stage: you are rushing, a lot of ideas come up, there is a catastrophic lack of time. As a result, other areas of life begin to shrink: there is no time for family, friends, sports – everything is crowded out by work. However, the drive from work at this stage is such that even knowing about the consequences, it is difficult to devote less time to it.

#2. Fatigue

Fatigue gradually begins to accumulate. The onset of this stage is indicated not only by fatigue, but also by growing irritation. Let’s say that before you were indifferent that a colleague likes to tap a pen on the table, but now it has become annoying. Decreased immunity and susceptibility to SARS is another symptom that you need a rest.

#3. Exhaustion

Then comes the stage of emotional exhaustion. Here, the symptoms that the WHO warned about are flourishing in full bloom: you don’t want anything, work is disgusting, performance is falling. At this stage, the body is desperately trying to convey the message: “You need to rest! Urgently! Relax!!!”

And if we continue to shove on (and we usually continue, we are not some kind of wimps), then the body says: “If you don’t want it in a good way, it will be bad for you”, and switches on the “illness” mode. Then we fall into depression, or something psychosomatic begins: the back hurts so much that it is impossible to sit in a chair, stomach problems arise, etc.

#4. The End

And, finally, the stage of irreversible exhaustion sets in. Irreversible for work. You begin to feel such disgust for her that no rest will save you. The body has firmly learned that this is the territory of death, you don’t need to go there, the only way out (after rest) is to change your profession.

How to deal with burnout syndrome

Each stage has its own methods.

Stage 1

Measures to help prevent burnout or cope with it before it goes beyond the first stage come down to the rules of mental hygiene. What will help?

Balance your life . This means finding a place in your life not only for work, but also for family, friends, hobbies, sports, and recreation. But since work takes up a significant part of life for a reason, you first need to figure out why this is happening. As a rule, this is a way to feel great, coping with different tasks and achieving results. And also the action of parental and social attitudes (not always realized) in the spirit: “Without me, everything will fall apart”, “Then I am worth something when I achieve something”, “Only a hardworking person can be respected”, etc.

Slow down . If you’re used to rushing headlong and focusing on your best performance when planning, then it’s worth becoming a realist. To do this, it is useful for a couple of months to honestly write down everything that you do. This is useful for three reasons at once:

1. You start to see how many things you actually get done. For example, I regularly experience a drop in productivity on Thursday. I know this and have no illusions that I can do as many things as on Wednesday.

2. If you are used to devaluing your work, you will see how much you actually do.

3. In addition, you will see where you spend time inefficiently. For example, they were stupid in social networks: they didn’t rest and didn’t work. Such an analysis helps to reallocate time and reserve it for meaningful things.

Surround yourself with support . We are talking about both a close circle that can listen and support in a difficult moment, and a professional community. For example, my wife is a psychologist in private practice, and professions that require a lot of interaction with people are especially prone to burnout. So, the wife has a powerful support factor – colleagues with whom you can sort out a difficult case, seek advice, or just whine when you get tired and want to handle it.

Stage #2

Learn to rest . In the second stage, it is critically important to organize a rest for yourself. It should be a complete rest, and not housework, self-development courses or training until you drop in the gym. It is equally important that this rest be:

• Daily . Batteries are important to recharge every day, so every day you need to provide time for recovery.

• Weekly . You need at least one full day off a week.

• And provided for vacation during the year . This does not have to be a one-time monthly vacation, it can be 4 weeks at different times of the year, most importantly, at this moment there should be a complete shutdown from work.

Quality rest has two criteria: irresponsibility (you don’t have to answer for anyone) and carelessness (you don’t have to worry about anything). It is clear that this does not always work out, but if you have a choice, you need to strive for just such a vacation.

Set boundaries . This can be done earlier, but at this stage it becomes critical to draw a line between personal life and work. You need to teach colleagues and clients not to pull you after hours, organize work so as not to take on urgent tasks and not put out fires. Of course, we are now talking about an ideal world, but if you start building boundaries, it turns out that 90 percent of everything important and urgent is not so important and urgent.

Delegate . Again, it is better to do this earlier, but at this stage for the leader it is a matter of survival.

Stage #3

At the exhaustion stage, it is too late to drink Borjomi. Only a long, at least three months, vacation, in which you need to fully relax, can help here. Why so long? You can’t fool the body. Processing is like a loan. Yes, at the moment you can borrow a resource, but then a hefty debt with interest accumulates. If you are at the stage of exhaustion, then you will have to recover from three months to six months.

The good news is that if you enjoy your job, you can recover and return to it.

Stage №4

And at this stage only rest and change of work help. And, most likely, you will have to change or thoroughly rethink the profession. Because you will hate the old one. For example, although I can do a little accounting work for my business, I could not work as a hired chief accountant – accounting still makes me sick.

Infographic from cv2you: about burnout with numbers

How to turn burnout to your advantage?

Most of the materials about professional burnout boil down to the fact that it is “horror-horror”. And although if we are talking about the last two stages, this is “horror”, but it is rarely “horror-horror” (excluding suicide, clinical depression, alcoholism and serious psychosomatics).

Professional burnout is a good opportunity to feel your own limitations and possibilities, learn to better manage your life and take care of yourself, and in some cases (as it was for me) it is an opportunity to find an activity that you really like.

There is a good phrase: “Experience is not what happens to a person, but what a person does with what happens to him.” What can professional burnout teach? Much:

1. Listen to your own emotions, feelings and thoughts in time. The task causes irritation, and why? Fatigue has arisen, and what can be done right now to exhale? Thinking about work? Why not write them out on a piece of paper and outline which of them should be implemented?

2. Make time for all areas of your life and work at your own pace.

3. Keep healthy. After all, diseases flourish when the immune system is weakened, and timely rest strengthens it.

4. Work more efficiently. Gates seems to have said that he will always choose a lazy person for a difficult job, because he will find an easy way to do it. Burnout also encourages you to look for easier ways.

5. Realize what really matters to you. What kind of work do you really like? What do you value in life. Faced with limitations, and burnout is always about strong limitation, pushes for such insights.

But what I love even more is the idea that you don’t have to burn yourself out to realize what’s important to you in life. For positive changes, it is enough just to take a serious interest in yourself in order to begin to better understand your life and rebuild it in an environmentally friendly way. I write a lot about this in my telegram channel, so if you are interested, subscribe.

How to get rid of professional burnout?

How to reduce the symptoms of professional burnout? Is it necessary to save a burnout employee or is it better to hire a new one?

Part 2

In May 2019, WHO included Burnout Syndrome in the International Classification of Diseases. This means that from 2022, with a diagnosis of chronic workplace stress syndrome that cannot be coped with, it will be possible to go on sick leave. In order not to lose valuable employees, large Russian companies have already learned how to reduce the symptoms of burnout. Let’s learn from them to extinguish the “hatred” of their favorite work.

Was it worth it?

Startup Svetlana is developing her own language school. She has already found the premises, the first clients and employees. To achieve the success of her offspring, Svetlana works without days off and holidays, she is literally on fire with new ideas.

But then:

• investors refused to support the project (failure)
• partner decided to leave for another business (conflict)
• profits were only enough to pay employees, but there was none left for themselves (injustice)
• miscalculated with the amount of payments and a debt appeared (errors and jambs).

After a series of such events, working 24/7 with constant force majeure, Svetlana burned out. Only yesterday she spoke and thought only about her own business, but today she does not even want to hear about it.

“I sit and think – was it worth it? Why should we continue?”

Causes and situations that provoke professional burnout

Psychologists say that it is very difficult to find the starting point of burnout. This condition is progressive. At first, you feel a strange indifference to the life around you. Gradually, emotional exhaustion accumulates and becomes obvious to others.

Svetlana Komissaruk also believes that dealing with the consequences is the wrong way. It is necessary to look for the cause of severe emotional exhaustion and eliminate it. The 3 main pitfalls of a goal-oriented person are processing, stress, and an excellent student complex. They are what lead to burnout in the profession.

Researchers at Yale University have found that engaged, hard-working employees burn out faster at work. That is, first of all, due to emotional exhaustion, companies risk losing the most responsible and diligent employees.

We eliminate the causes of employee burnout

1

We remove processing

We have already found out in the last article that 87% of employees periodically work overtime in Russian companies. Overtime is the first cause of physical and mental exhaustion in workers.

An irregular working day provokes not only psychological emptiness. In Japan, where office workers sometimes work 50 or more hours a week, a terrifying social phenomenon is gaining momentum – death by overwork (karoshi). In 2015, there were 2,310 reported cases of Karoshi in Japan in a year. A similar phenomenon occurs in other developing countries: India, South Korea, Taiwan, China.

To return the balance of working time for an employee, you must:

• follow the vacation schedule
• give the option to disconnect from work tasks. Do not send e-mails for work after the end of the working day, do not load work on weekends and holidays
• restore equality of duties. Highly qualified employees are often overworked. According to the recruiting agency Hays, more than 40% of specialists are demotivated by such a lack of clear terms of reference
• take regular lunch breaks and short breaks during the working day.

2

Reduce stress

One of the 3 most important causes of professional burnout is an increased level of stress. To prevent and reduce the risk of emotional exhaustion syndrome, it is necessary, firstly, to reduce the level of stress as much as possible, and secondly, to learn to coexist with it.

How?

• create a comfortable workplace
• equip a rest room at work
• organize hobbies and activities after work (sports, yoga, dancing, gym membership)
• maintain a friendly atmosphere within the team and with superiors
• invite a psychologist. It will help to reveal the true inclinations and abilities of a person, help build your career path
• make repairs in the office (repaint the walls, swap tables and cabinets)
• learn to cope with stress. Stress will not go anywhere and you need to learn how to reboot. These can be relaxation procedures, meditations, breathing exercises, etc.

3

Struggling with perfectionism and an excellent student complex

Social psychologist Svetlana Komissaruk emphasizes that the more important it is for you not to make a mistake, the more you are prone to burnout.

How to deal with it:

• Make sure your goals are realistic. There is an opinion that high and ambitious goals should spur motivation. But statistics show that only some employees increase productivity from high goals. For others, an overestimated level of leadership ambitions, on the contrary, reduces motivation, causes excitement, stress, and exhaustion. So make sure the goals are achievable for the employees.
• Add resources to achieve goals (increase salaries, bonuses, invite competent specialists, conduct training, etc.).
• Check if the employee and you are in your place. Ask employees what they would like to do less and what they like more in their work. This will help in time to detect the first symptoms of “hatred” for an unloved job.

What if you are a leader and you are on fire?

Let’s go back to Svetlana, the founder of the language school, and analyze the reasons for her burnout.

Svetlana is too immersed in routine and operational processes. Behind these problems, Svetlana forgot about the higher goals for which she created her business. But a burned-out leader is a tyrant for employees. He is always irritated, lashes out and yells at his subordinates. According to Hays surveys, pressure from management is one of the top 3 causes of stress in the workplace among employees.

The key task of the leader is to reboot and return to the “high state”. To do this, you need to move away from work issues.

Here’s what Ganna Paramonova, career consultant advises to do in case of burnout symptoms:

“Get off a dead horse” or save a burnout employee?

The benefits of “fresh blood” are fairly common:

However, career specialists of large companies today have a different opinion. For example, Victoria Mikhmel, head of the VM-Group recruiting agency, says: “If an employee has already been trained and gave the desired result, of course, it is beneficial to restore him” .

In Russia, it is possible to connect an employee to special online services. There, burnt-out workers can get psychological counseling completely anonymously and at the expense of the company.

In addition, large holding companies have a rotation system. If a person burns out in one place, he has the opportunity to correctly, observing certain conditions, move to another unit.

How to solve the problem of burnout in large Russian companies

Large Russian companies have various employee support programs

• In Mail.Ru Group, employees participate in educational programs, train others and participate in trainings.
• L’Oreal Russia listens to the wishes of employees and gives them more days off, makes a flexible schedule
• Sibur Holding trains employees in special physical exercises to help cope with stress.