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Mostafa R, El-Atawi K. Strategies to Measure and Improve Emergency Department Performance: A Review. Cureus 2024; 16:e52879. [PMID: 38406097 PMCID: PMC10890971 DOI: 10.7759/cureus.52879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Emergency Departments (EDs) globally face escalating challenges such as overcrowding, resource limitations, and increased patient demand. This study aims to identify and analyze strategies to enhance the structural performance of EDs, with a focus on reducing overcrowding, optimizing resource allocation, and improving patient outcomes. Through a comprehensive review of the literature and observational studies, the research highlights the effectiveness of various approaches, including triage optimization, dynamic staffing, technological integration, and strategic resource management. Key findings indicate that tailored strategies, such as implementing advanced triage protocols and leveraging telemedicine, can significantly reduce wait times and enhance patient throughput. Furthermore, evidence suggests that dynamic staffing models and the integration of cutting-edge diagnostic tools contribute to operational efficiency and improved quality of care. These strategies, when combined, offer a multifaceted solution to the complex challenges faced by EDs, promising better patient care and satisfaction. The study underscores the need for a comprehensive approach, incorporating both organizational and technological innovations, to address the evolving needs of emergency healthcare.
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Affiliation(s)
- Reham Mostafa
- Department of Emergency Medicine, Al Zahra Hospital Dubai (AZHD), Dubai, ARE
| | - Khaled El-Atawi
- Pediatrics/ Neonatal Intensive Care Unit, Latifa Women and Children Hospital, Dubai, ARE
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Evans LV, Ray JM, Bonz JW, Joseph M, Gerwin JN, Dziura JD, Venkatesh AK, Wong AH. Improving patient and clinician safety during COVID-19 through rapidly adaptive simulation and a randomised controlled trial: a study protocol. BMJ Open 2022; 12:e058980. [PMID: 35589358 PMCID: PMC9121107 DOI: 10.1136/bmjopen-2021-058980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION COVID-19 required healthcare systems to iteratively adapt for safe and up-to-date care as knowledge of the disease rapidly evolved. Rates of COVID-19 infections continue to fluctuate and patients without COVID-19 increasingly return to the emergency department (ED) for care. This leads to new challenges and threats to patient and clinician safety as suspected patients with COVID-19 need to be quickly detected and isolated among other patients with non-COVID-19-related illnesses. At the front lines, emergency physicians also face continued personal safety concerns and increased work burden, which heighten stress and anxiety, especially given the prolonged course of the pandemic. Burnout, already a serious concern for emergency physicians due to the cumulative stresses of their daily practice, may present as a longer-term outcome of these acute stressors. METHODS AND ANALYSIS We will implement a rapidly adaptive simulation-based approach to understand and improve physician preparedness while decreasing physician stress and anxiety. First, we will conduct semi-structured qualitative interviews and human factor observations to determine the challenges and facilitators of COVID-19 preparedness and mitigation of physician stress. Next, we will conduct a randomised controlled trial to test the effectiveness of a simulation preparedness intervention on physician physiological stress as measured by decreased heart rate variability on shift and anxiety as measured by the State-Trait Anxiety Inventory. ETHICS AND DISSEMINATION The protocol was reviewed and approved by the Agency for Healthcare Research and Quality for funding, and ethics approval was obtained from the Yale University Human Investigation Committee in 2020 (HIC# 2000029370 and 2000029372). To support ongoing efforts to address clinician stress and preparedness, we will strategically disseminate the simulation intervention to areas most impacted by COVID-19. Using a virtual telesimulation and webinar format, the dissemination efforts will provide hands-on learning for ED and hospital administrators as well as simulation educators. TRIAL REGISTRATION NUMBER NCT04614844.
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Affiliation(s)
- Leigh V Evans
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jessica M Ray
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - James W Bonz
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Melissa Joseph
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeffrey N Gerwin
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - James D Dziura
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Nishi M, Yamano M, Matoba S. Prediction of well-being and insight into work-life integration among physicians using machine learning approach. PLoS One 2021; 16:e0254795. [PMID: 34265012 PMCID: PMC8282024 DOI: 10.1371/journal.pone.0254795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/03/2021] [Indexed: 11/19/2022] Open
Abstract
There has been increasing interest in examining physician well-being and its predictive factors. However, few studies have revealed the characteristics associated with physician well-being and work-life integration using a machine learning approach. To investigate predictive factors of well-being and obtain insights into work-life integration, the survey was conducted by letter mail in a sample of Japanese physicians. A total of 422 responses were collected from 846 physicians. The mean age was 47.9 years, males constituted 83.3% of the physicians, and 88.6% were considered to be well. The most accurate machine learning model showed a mean area under the curve of 0.72. The mean permutation importance of career satisfaction, work hours per week, existence of family support, gender, and existence of power harassment were 0.057, 0.022, 0.009, 0.01, and 0.006, respectively. Using a machine learning model, physician well-being could be predicted. It seems to be influenced by multiple factors, such as career satisfaction, work hours per week, family support, gender, and power harassment. Career satisfaction has the highest impact, while long work hours have a negative effect on well-being. These findings support the need for organizational interventions to promote physician well-being and improve the quality of medical care.
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Affiliation(s)
- Masahiro Nishi
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Cardiovascular Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Jenkins D, Thomas SA, Pathan SA, Thomas SH. Increasing consultant-level staffing as a proportion of overall physician coverage improves emergency department length of stay targets. BMC Emerg Med 2021; 21:5. [PMID: 33441082 PMCID: PMC7805094 DOI: 10.1186/s12873-020-00399-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022] Open
Abstract
Objectives One goal of Emergency Department (ED) operations is achieving an overall length of stay (LOS) that is less than four hours. The goal of the current study was to assess for association between increasing number of on-duty EM Consultants and LOS, while adjusting for overall (all-grade) on-duty emergency doctors’ numbers and other operational factors. Methods This was a retrospective analysis of three years (2016–2019) of data, employing a unit of analysis of 3276 eight-hour ED shifts. The study was conducted using a prospectively populated ED database in a busy (annual census 420,000) Middle Eastern ED with staffing by Consultants and multiple non-Consultant grades (Specialists, fellows, and residents). Using logistic regression, the main predictor variable of “on-duty Consultant n” was assessed for association with the study’s primary (dichotomous) endpoint: whether a shift’s median LOS met the target of < 240 min. Linear regression was used to assess for association between on-duty Consultant n and the study’s secondary (continuous) endpoint: median LOS for the ED shift. Results Multivariate logistic regression adjusting for a number of operations factors (including total EP on-duty complement) identified an association between increasing n of on-duty Consultants and the likelihood of a shift’s meeting the 4-h ED LOS target (OR 1.27, 95% CI 1.20 to 1.34, p < .0001). Multiple linear regression, which also adjusted for total on-duty EP n and other operational factors, also indicated LOS benefit from more on-duty Consultants: each additional on-duty Consultant was associated with a shift’s median LOS improving by 5.4 min (95% CI 4.3 to 6.5, p < .0001). Conclusions At the study site, in models that adjusted for overall on-duty EP numbers as well as myriad other operational factors, increasing numbers of on-duty Consultants was associated with a statistically and operationally significant reduction in ED LOS. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-020-00399-8.
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Affiliation(s)
- Dominic Jenkins
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar
| | | | - Sameer A Pathan
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Stephen H Thomas
- Department of Emergency Medicine, Hamad General Hospital, Doha, Qatar.,Blizard Institute, Barts & The London School of Medicine, Queen Mary University of London, London, UK
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Sahebi A, Golitaleb M, Jahangiri K. Occupational Burnout in Pre-Hospital Emergency Personnel in Iran: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:11-17. [PMID: 33954093 PMCID: PMC8074727 DOI: 10.4103/ijnmr.ijnmr_175_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/12/2020] [Accepted: 09/20/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Occupational burnout, as a reaction to persistent work pressures, reduces efficiency, wastes manpower, and causes physical and psychological complications. The aim of this study was to determine the frequency and intensity of occupational burnout among pre-hospital emergency staff in Iran. MATERIALS AND METHODS This study was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data resources included Scientific Information Database (SID), Magiran, Islamic World Science Citation Center (ISC), Irandoc, PubMed, Scopus, Web of Science, and Google Scholar. RESULTS Initially, 178 articles were extracted, and then 13 articles were finally analyzed. Overall,2034 pre-hospital emergency personnel were examined. Mean of occupational burnout in term of frequency, respectively for emotional exhaustion (16.78, 95% CI = 8.89-24.67, I2 = 62.30%, p = 0.004), depersonalization (11.57, 95% CI = 6.97-16.18, I2 = 68.50%, p = 0.001) and the lack of personal accomplishment (16.11, 95% CI = 8.60 -23.62, I2 = 74.70%, p = 0 <001) were determined. Also, in term of intensity, respectively for emotional exhaustion (17.90, 95% CI = 8.24-27.57, I2 = 64.80, p = 0.004), depersonalization (11.20, 95% CI = 6.80-16.22, I2 = 49.60%, p = 0.044) and the lack of personal accomplishment (23.45, 95% CI = 13.41 -33.49, I2 = 84.80%, p = 0 <001) were determined. CONCLUSIONS According to findings, depersonalization and lack of personal accomplishment had moderate and high-level, respectively. Therefore, it is necessary health policymakers pay special attention to identifying and resolving the causes of occupational burnout in this population.
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Affiliation(s)
- Ali Sahebi
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohamad Golitaleb
- Department of Nursing, School of Nursing and Midwifery, Arak University of Medical Sciences, Arak, Iran
| | - Katayoun Jahangiri
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Garcia LC, Shanafelt TD, West CP, Sinsky CA, Trockel MT, Nedelec L, Maldonado YA, Tutty M, Dyrbye LN, Fassiotto M. Burnout, Depression, Career Satisfaction, and Work-Life Integration by Physician Race/Ethnicity. JAMA Netw Open 2020; 3:e2012762. [PMID: 32766802 PMCID: PMC7414389 DOI: 10.1001/jamanetworkopen.2020.12762] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Previous research suggests that the prevalence of occupational burnout varies by demographic characteristics, such as sex and age, but the association between physician race/ethnicity and occupational burnout is less well understood. OBJECTIVE To investigate possible differences in occupational burnout, depressive symptoms, career satisfaction, and work-life integration by race/ethnicity in a sample of US physicians. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, data for this secondary analysis of 4424 physicians were originally collected from a cross-sectional survey of US physicians between October 12, 2017, and March 15, 2018. The dates of analysis were March 8, 2019, to May 21, 2020. Multivariable logistic regression, including statistical adjustment for physician demographic and clinical practice characteristics, was performed to examine the association between physician race/ethnicity and occupational burnout, depressive symptoms, career satisfaction, and work-life integration. EXPOSURES Physician demographic and clinical practice characteristics included race/ethnicity, sex, age, clinical specialty, hours worked per week, primary practice setting, and relationship status. MAIN OUTCOMES AND MEASURES Physicians with a high score on the emotional exhaustion or depersonalization subscale of the Maslach Burnout Inventory were classified as having burnout. Depressive symptoms were measured using the Primary Care Evaluation of Mental Disorders instrument. Physicians who marked "strongly agree" or "agree" in response to the survey items "I would choose to become a physician again" and "My work schedule leaves me enough time for my personal/family life" were considered to be satisfied with their career and work-life integration, respectively. RESULTS Data were available for 4424 physicians (mean [SD] age, 52.46 [12.03] years; 61.5% [2722 of 4424] male). Most physicians (78.7% [3480 of 4424]) were non-Hispanic White. Non-Hispanic Asian, Hispanic/Latinx, and non-Hispanic Black physicians comprised 12.3% (542 of 4424), 6.3% (278 of 4424), and 2.8% (124 of 4424) of the sample, respectively. Burnout was observed in 44.7% (1540 of 3447) of non-Hispanic White physicians, 41.7% (225 of 540) of non-Hispanic Asian physicians, 38.5% (47 of 122) of non-Hispanic Black physicians, and 37.4% (104 of 278) of Hispanic/Latinx physicians. The adjusted odds of burnout were lower in non-Hispanic Asian physicians (odds ratio [OR], 0.77; 95% CI, 0.61-0.96), Hispanic/Latinx physicians (OR, 0.63; 95% CI, 0.47-0.86), and non-Hispanic Black physicians (OR, 0.49; 95% CI, 0.30-0.79) compared with non-Hispanic White physicians. Non-Hispanic Black physicians were more likely to report satisfaction with work-life integration compared with non-Hispanic White physicians (OR, 1.69; 95% CI, 1.05-2.73). No differences in depressive symptoms or career satisfaction were observed by race/ethnicity. CONCLUSIONS AND RELEVANCE Physicians in minority racial/ethnic groups were less likely to report burnout compared with non-Hispanic White physicians. Future research is necessary to confirm these results, investigate factors contributing to increased rates of burnout among non-Hispanic White physicians, and assess factors underlying the observed patterns in measures of physician wellness by race/ethnicity.
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Affiliation(s)
- Luis C. Garcia
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Tait D. Shanafelt
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- WellMD Center, Stanford University School of Medicine, Stanford, California
| | - Colin P. West
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Mickey T. Trockel
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California
| | - Laurence Nedelec
- WellMD Center, Stanford University School of Medicine, Stanford, California
| | - Yvonne A. Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | | | | | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
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Tawfik DS, Scheid A, Profit J, Shanafelt T, Trockel M, Adair KC, Sexton JB, Ioannidis JPA. Evidence Relating Health Care Provider Burnout and Quality of Care: A Systematic Review and Meta-analysis. Ann Intern Med 2019; 171:555-567. [PMID: 31590181 PMCID: PMC7138707 DOI: 10.7326/m19-1152] [Citation(s) in RCA: 250] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Whether health care provider burnout contributes to lower quality of patient care is unclear. PURPOSE To estimate the overall relationship between burnout and quality of care and to evaluate whether published studies provide exaggerated estimates of this relationship. DATA SOURCES MEDLINE, PsycINFO, Health and Psychosocial Instruments (EBSCO), Mental Measurements Yearbook (EBSCO), EMBASE (Elsevier), and Web of Science (Clarivate Analytics), with no language restrictions, from inception through 28 May 2019. STUDY SELECTION Peer-reviewed publications, in any language, quantifying health care provider burnout in relation to quality of patient care. DATA EXTRACTION 2 reviewers independently selected studies, extracted measures of association of burnout and quality of care, and assessed potential bias by using the Ioannidis (excess significance) and Egger (small-study effect) tests. DATA SYNTHESIS A total of 11 703 citations were identified, from which 123 publications with 142 study populations encompassing 241 553 health care providers were selected. Quality-of-care outcomes were grouped into 5 categories: best practices (n = 14), communication (n = 5), medical errors (n = 32), patient outcomes (n = 17), and quality and safety (n = 74). Relations between burnout and quality of care were highly heterogeneous (I2 = 93.4% to 98.8%). Of 114 unique burnout-quality combinations, 58 indicated burnout related to poor-quality care, 6 indicated burnout related to high-quality care, and 50 showed no significant effect. Excess significance was apparent (73% of studies observed vs. 62% predicted to have statistically significant results; P = 0.011). This indicator of potential bias was most prominent for the least-rigorous quality measures of best practices and quality and safety. LIMITATION Studies were primarily observational; neither causality nor directionality could be determined. CONCLUSION Burnout in health care professionals frequently is associated with poor-quality care in the published literature. The true effect size may be smaller than reported. Future studies should prespecify outcomes to reduce the risk for exaggerated effect size estimates. PRIMARY FUNDING SOURCE Stanford Maternal and Child Health Research Institute.
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Affiliation(s)
- Daniel S Tawfik
- Stanford University School of Medicine, Stanford, California (D.S.T., T.S., M.T.)
| | - Annette Scheid
- Brigham and Women's Hospital and Harvard Medical School, llBoston, Massachusetts (A.S.)
| | - Jochen Profit
- Stanford University School of Medicine, Stanford, California, and California Perinatal Quality Care Collaborative, Palo Alto, California (J.P.)
| | - Tait Shanafelt
- Stanford University School of Medicine, Stanford, California (D.S.T., T.S., M.T.)
| | - Mickey Trockel
- Stanford University School of Medicine, Stanford, California (D.S.T., T.S., M.T.)
| | - Kathryn C Adair
- Duke University School of Medicine, Duke University Health System, and Duke Patient Safety Center, Durham, North Carolina (K.C.A., J.B.S.)
| | - J Bryan Sexton
- Duke University School of Medicine, Duke University Health System, and Duke Patient Safety Center, Durham, North Carolina (K.C.A., J.B.S.)
| | - John P A Ioannidis
- Stanford University School of Medicine, Stanford University School of Humanities and Sciences, and Meta-Research Innovation Center at Stanford (METRICS), Stanford, California (J.P.I.)
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Koutsimani P, Montgomery A, Georganta K. The Relationship Between Burnout, Depression, and Anxiety: A Systematic Review and Meta-Analysis. Front Psychol 2019; 10:284. [PMID: 30918490 PMCID: PMC6424886 DOI: 10.3389/fpsyg.2019.00284] [Citation(s) in RCA: 409] [Impact Index Per Article: 81.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/29/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Burnout is a psychological syndrome characterized by emotional exhaustion, feelings of cynicism and reduced personal accomplishment. In the past years there has been disagreement on whether burnout and depression are the same or different constructs, as they appear to share some common features (e.g., loss of interest and impaired concentration). However, the results so far are inconclusive and researchers disagree with regard to the degree to which we should expect such overlap. The aim of this systematic review and meta-analysis is to examine the relationship between burnout and depression. Additionally, given that burnout is the result of chronic stress and that working environments can often trigger anxious reactions, we also investigated the relationship between burnout and anxiety. Method: We searched the online databases SCOPUS, Web of Science, MEDLINE (PubMed), and Google Scholar for studies examining the relationship between burnout and depression and burnout and anxiety, which were published between January 2007 and August 2018. Inclusion criteria were used for all studies and included both cross-sectional and longitudinal designs, published and unpublished research articles, full-text articles, articles written in the English language, studies that present the effects sizes of their findings and that used reliable research tools. Results: Our results showed a significant association between burnout and depression (r = 0.520, SE = 0.012, 95% CI = 0.492, 0.547) and burnout and anxiety (r = 0.460, SE = 0.014, 95% CI = 0.421, 0.497). However, moderation analysis for both burnout-depression and burnout-anxiety relationships revealed that the studies in which either the MBI test was used or were rated as having better quality showed lower effect sizes. Conclusions: Our research aims to clarify the relationship between burnout-depression and burnout-anxiety relationships. Our findings revealed no conclusive overlap between burnout and depression and burnout and anxiety, indicating that they are different and robust constructs. Future studies should focus on utilizing more longitudinal designs in order to assess the causal relationships between these variables.
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Affiliation(s)
| | - Anthony Montgomery
- Department of Educational & Social Policy, School of Social Sciences, Humanities and Arts, University of Macedonia, Thessaloniki, Greece
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Yoo J, Jung KY, Kim T, Lee T, Hwang SY, Yoon H, Shin TG, Sim MS, Jo IJ, Paeng H, Choi JS, Cha WC. A Real-Time Autonomous Dashboard for the Emergency Department: 5-Year Case Study. JMIR Mhealth Uhealth 2018; 6:e10666. [PMID: 30467100 PMCID: PMC6284143 DOI: 10.2196/10666] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 07/02/2018] [Accepted: 08/10/2018] [Indexed: 01/23/2023] Open
Abstract
Background The task of monitoring and managing the entire emergency department (ED) is becoming more important due to increasing pressure on the ED. Recently, dashboards have received the spotlight as health information technology to support these tasks. Objective This study aimed to describe the development of a real-time autonomous dashboard for the ED and to evaluate perspectives of clinical staff on its usability. Methods We developed a dashboard based on three principles—“anytime, anywhere, at a glance;” “minimal interruption to workflow;” and “protect patient privacy”—and 3 design features—“geographical layout,” “patient-level alert,” and “real-time summary data.” Items to evaluate the dashboard were selected based on the throughput factor of the conceptual model of ED crowding. Moreover, ED physicians and nurses were surveyed using the system usability scale (SUS) and situation awareness index as well as a questionnaire we created on the basis of the construct of the Situation Awareness Rating Technique. Results The first version of the ED dashboard was successfully launched in 2013, and it has undergone 3 major revisions since then because of geographical changes in ED and modifications to improve usability. A total of 52 ED staff members participated in the survey. The average SUS score of the dashboard was 67.6 points, which indicates “OK-to-Good” usability. The participants also reported that the dashboard provided efficient “concentration support” (4.15 points), “complexity representation” (4.02 points), “variability representation” (3.96 points), “information quality” (3.94 points), and “familiarity” (3.94 points). However, the “division of attention” was rated at 2.25 points. Conclusions We developed a real-time autonomous ED dashboard and successfully used it for 5 years with good evaluation from users.
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Affiliation(s)
- Junsang Yoo
- SAIHST, Department of Digital Health, Sungkyunkwan University, Seoul, Republic of Korea
| | - Kwang Yul Jung
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taerim Lee
- Department of Emergency Medicine, Chamjoeun Hospital, Gwangju, Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hansol Paeng
- Human Understanding Design Center (HUDC), Seoul Medical Center, Seoul, Republic of Korea
| | - Jong Soo Choi
- SAIHST, Department of Digital Health, Sungkyunkwan University, Seoul, Republic of Korea.,Health Information Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Health Information Center, Samsung Medical Center, Seoul, Republic of Korea.,Department of Digital Health, Samsung Advanced Institute of Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
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Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S, Mata DA. Prevalence of Burnout Among Physicians: A Systematic Review. JAMA 2018; 320:1131-1150. [PMID: 30326495 PMCID: PMC6233645 DOI: 10.1001/jama.2018.12777] [Citation(s) in RCA: 947] [Impact Index Per Article: 157.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/09/2018] [Indexed: 12/13/2022]
Abstract
Importance Burnout is a self-reported job-related syndrome increasingly recognized as a critical factor affecting physicians and their patients. An accurate estimate of burnout prevalence among physicians would have important health policy implications, but the overall prevalence is unknown. Objective To characterize the methods used to assess burnout and provide an estimate of the prevalence of physician burnout. Data Sources and Study Selection Systematic search of EMBASE, ERIC, MEDLINE/PubMed, psycARTICLES, and psycINFO for studies on the prevalence of burnout in practicing physicians (ie, excluding physicians in training) published before June 1, 2018. Data Extraction and Synthesis Burnout prevalence and study characteristics were extracted independently by 3 investigators. Although meta-analytic pooling was planned, variation in study designs and burnout ascertainment methods, as well as statistical heterogeneity, made quantitative pooling inappropriate. Therefore, studies were summarized descriptively and assessed qualitatively. Main Outcomes and Measures Point or period prevalence of burnout assessed by questionnaire. Results Burnout prevalence data were extracted from 182 studies involving 109 628 individuals in 45 countries published between 1991 and 2018. In all, 85.7% (156/182) of studies used a version of the Maslach Burnout Inventory (MBI) to assess burnout. Studies variably reported prevalence estimates of overall burnout or burnout subcomponents: 67.0% (122/182) on overall burnout, 72.0% (131/182) on emotional exhaustion, 68.1% (124/182) on depersonalization, and 63.2% (115/182) on low personal accomplishment. Studies used at least 142 unique definitions for meeting overall burnout or burnout subscale criteria, indicating substantial disagreement in the literature on what constituted burnout. Studies variably defined burnout based on predefined cutoff scores or sample quantiles and used markedly different cutoff definitions. Among studies using instruments based on the MBI, there were at least 47 distinct definitions of overall burnout prevalence and 29, 26, and 26 definitions of emotional exhaustion, depersonalization, and low personal accomplishment prevalence, respectively. Overall burnout prevalence ranged from 0% to 80.5%. Emotional exhaustion, depersonalization, and low personal accomplishment prevalence ranged from 0% to 86.2%, 0% to 89.9%, and 0% to 87.1%, respectively. Because of inconsistencies in definitions of and assessment methods for burnout across studies, associations between burnout and sex, age, geography, time, specialty, and depressive symptoms could not be reliably determined. Conclusions and Relevance In this systematic review, there was substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality. These findings preclude definitive conclusions about the prevalence of burnout and highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians.
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Affiliation(s)
- Lisa S. Rotenstein
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Brigham Education Institute, Boston, Massachusetts
| | - Matthew Torre
- Harvard Medical School, Boston, Massachusetts
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Marco A. Ramos
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Rachael C. Rosales
- Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | - Srijan Sen
- Molecular and Behavioral Neuroscience Institute and Department of Psychiatry, University of Michigan, Ann Arbor
| | - Douglas A. Mata
- Harvard Medical School, Boston, Massachusetts
- Brigham Education Institute, Boston, Massachusetts
- Program in Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
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Affiliation(s)
- Richard Everard Wolfe
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, USA.
| | - Leon Dahomey Sanchez
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, USA
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