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- (-) Burnout (20)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 20 of 20 Research Studies DisplayedWatterson TL, Steege LM, Mott DA
Sociotechnical work system approach to occupational fatigue.
The impact of occupational fatigue has been researched in fields outside of health care such as transportation and industry. Studies with health care professionals such as physicians, medical residents, and nurses has highlighted the potential for occupational fatigue to affect patient, employee, and organizational outcomes. The researchers advise that a conceptual framework of occupational fatigue that is informed by a sociotechnical systems approach is needed. The purpose of this paper was to outline the health care professional occupational fatigue conceptual framework by following the Systems Engineering Initiative for Patient Safety (SEIPS) model and adapting the Conceptual Model of Occupational Fatigue in Nursing.
AHRQ-funded; HS027766.
Citation: Watterson TL, Steege LM, Mott DA .
Sociotechnical work system approach to occupational fatigue.
Jt Comm J Qual Patient Saf 2023 Sep; 49(9):485-93. doi: 10.1016/j.jcjq.2023.05.007..
Keywords: Provider: Health Personnel, Burnout
Apathy NC, Rotenstein L, Bates DW NC, Rotenstein L, Bates DW
Documentation dynamics: note composition, burden, and physician efficiency.
This study’s objective was to analyze how physician clinical note length and composition relate to electronic health record (EHR)-based measures of burden and efficiency that have been tied to burnout. This cross-sectional study examined EHR metadata capturing physician-level measures from 203,728 US-based ambulatory physicians using the Epic Systems EHR between September 2020 and May 2021. The authors calculated physician-level averages for four measures of interest and assigned physicians to overall note length deciles and note composition deciles from six sources, including templated text, manual text, and copy/paste text. They found that physicians in the top decile of note length demonstrated greater burden and lower efficiency than physicians in the median decile level, spending 39% more time in the EHR after hours and closing 5.6 percentage points fewer visits on the same day. Copy/paste use demonstrated a similar dose/response relationship, with top-decile copy/paste users closing 6.8 percentage points fewer visits on the same day and spending more time in the EHR after hours and on days off. Templated text such as Epic’s SmartTools demonstrated a non-linear relationship with burden and efficiency, with very low and very high levels of use associated with increased EHR burden and decreased efficiency.
AHRQ-funded; HS026116.
Citation: Apathy NC, Rotenstein L, Bates DW NC, Rotenstein L, Bates DW .
Documentation dynamics: note composition, burden, and physician efficiency.
Health Serv Res 2023 Jun; 58(3):674-85. doi: 10.1111/1475-6773.14097..
Keywords: Provider: Physician, Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT)
Watterson TL, Chui MA
Subjective perceptions of occupational fatigue in community pharmacists.
The objective of this study was to describe subjective perceptions of occupational fatigue in community pharmacists. Wisconsin pharmacists who were eligible to participate completed a demographic questionnaire, a Pharmacist Fatigue Instrument, and semi-structured interview. Interview results were separated into overarching themes that included mental fatigue, physical fatigue, active fatigue, and passive fatigue. The researchers concluded that interventions aimed at improving occupational fatigue in community pharmacies should consider key themes of fatigue that pharmacists experience.
AHRQ-funded; HS027766.
Citation: Watterson TL, Chui MA .
Subjective perceptions of occupational fatigue in community pharmacists.
Pharmacy 2023 May 9; 11(3):84. doi: 10.3390/pharmacy11030084..
Keywords: Provider: Pharmacist, Burnout
Quigley DD, Slaughter ME, Qureshi N
Associations of pediatric nurse burnout with involvement in quality improvement.
The purpose of this study was to explore the relationships of inpatient pediatric nurse burnout with their perceptions on the importance of quality at the hospital, and with patient experience measurement, quality improvement (QI), unit culture, and staffing. The researchers implemented a cross-sectional study at an urban children's hospital and surveyed pediatric nurses about their perceptions including the Maslach Burnout Inventory. The study found that 27% of pediatric nurses reported burnout. Nurses who possessed greater confidence in patient experience measurement, received frequent patient experience performance reports, felt included in QI, and experienced QI efforts as integrated into patient care reported not being burned out when compared to those reporting burnout. Higher levels of open communication among nurses and unit-level teamwork were also related with lack of burnout, and a higher QI workload was related with burnout.
AHRQ-funded; HS025920.
Citation: Quigley DD, Slaughter ME, Qureshi N .
Associations of pediatric nurse burnout with involvement in quality improvement.
J Pediatr Nurs 2023 May-Jun; 70:e9-e16. doi: 10.1016/j.pedn.2022.11.001..
Keywords: Children/Adolescents, Burnout, Provider: Nurse, Quality Improvement, Quality of Care
Casalino LP, Jung HY, Bodenheimer T
The association of teamlets and teams with physician burnout and patient outcomes.
This cross-sectional observational study’s goal was to determine the prevalence and performance of primary care teamlets and teams. Survey participants included 688 general internists and family physicians. Physicians were assigned to one of four teamlet/team categories (e.g., teamlet/no team) and, in secondary analyses, to one of eight teamlet/team categories that classified teamlets into high, medium, and low collaboration as perceived by the physician (e.g., teamlet perceived-high collaboration/no team) based on their responses. The majority of physicians (77.4%) practiced in teamlets; 36.7% in teams. The four categories were divided as follows: 49.1% practiced in the teamlet/no team category; 28.3% in the teamlet/team category; 8.4% in no teamlet/team; 14.1% in no teamlet/no team. Results showed that 15.7%, 47.4%, and 14.4% of physicians practiced in perceived high-, medium-, and low-collaboration teamlets. Physicians who did not practice in a teamlet or team had significantly lower rate of burnout compared to the three teamlet/team categories. There were no significant differences in outcomes or Medicare spending by teamlet/team or teamlet perceived-collaboration/team categories compared to no teamlet/no team, for Medicare beneficiaries in general, or for dual-eligible beneficiaries.
AHRQ-funded; HS025716.
Citation: Casalino LP, Jung HY, Bodenheimer T .
The association of teamlets and teams with physician burnout and patient outcomes.
J Gen Intern Med 2023 May; 38(6):1384-92. doi: 10.1007/s11606-022-07894-7..
Keywords: Teams, Burnout, Primary Care, Provider: Physician
Barger LK, Weaver MD, Sullivan JP
Impact of work schedules of senior resident physicians on patient and resident physician safety: nationwide, prospective cohort study.
The purpose of this study was to determine if long weekly work hours and shifts of extended duration are associated with adverse patient and physician safety outcomes. The criteria included work hours and shifts (≥24 hours) and for senior resident physicians (postgraduate year 2 and above; PGY2+). This study was conducted in the U.S. and spanned eight academic years. The analysis concluded that working 48 hours per week or longer, and extended shifts endanger even experienced (ie, PGY2+) resident physicians and their patients. It recommends lowering weekly work hour limits, as the European Union has done, and eliminating shifts of extended duration to protect the more than 150 000 physicians training in the US and their patients.
AHRQ-funded; HS012032.
Citation: Barger LK, Weaver MD, Sullivan JP .
Impact of work schedules of senior resident physicians on patient and resident physician safety: nationwide, prospective cohort study.
BMJ Med 2023; 2(1):e000320. doi: 10.1136/bmjmed-2022-000320..
Keywords: Provider: Physician, Burnout, Patient Safety
Tawfik DS, Adair KC, Palassof S
Leadership behavior associations with domains of safety culture, engagement, and health care worker well-being.
This study evaluated health care worker leadership behaviors in relation to burnout, safety culture, and engagement using the Local Leadership scale of the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey. The SCORE survey was administered to 31 Midwestern hospitals with domains including Local Leadership, Emotional Exhaustion/Burnout, Safety Climate, and Engagement. Out of 23,853 distributed surveys, 70.4% were returned. Local leadership scores averaged 68.8 ± 29.1, with 44.2% reporting emotional exhaustion, 55.9% reporting concerning safety climate, 68.4% reporting concerning teamwork climate, 47.5% reporting high workload, and 20.7% reporting intentions to leave. Each 10-point increase in local leadership score was associated with odds ratios of 0.72 for burnout, 0.48 for concerning safety climate, 0.64 for concerning teamwork climate, 0.90 for high workload, and 0.80 for intentions to leave, after adjustment for unit and provider characteristics.
AHRQ-funded; HS027837.
Citation: Tawfik DS, Adair KC, Palassof S .
Leadership behavior associations with domains of safety culture, engagement, and health care worker well-being.
Jt Comm J Qual Patient Saf 2023 Mar; 49(3):156-65. doi: 10.1016/j.jcjq.2022.12.006..
Keywords: Burnout, Provider: Health Personnel
Giordano NA, Swan BA, Johnson TM
Scalable and sustainable approaches to address the well-being of healthcare personnel.
This article discusses current research that stemmed from a HRSA grant to implement interventions to reduce burnout and optimize behavioral health in the healthcare workforce as part of their Health and Public Safety Workforce Resilient Training Program. A total of 34 awards were made, with the common focus on implementing individual-level mindfulness and compassion-based interventions. The authors are one of the awardees and discuss their efforts to implement a program called Atlanta’s Resiliency Resource fOr frontline Workers (ARROW). This program offers comprehensive resources for resiliency enrichment, mindfulness training and professional development for clinicians and staff working within metropolitan Atlanta healthcare systems. The authors hope to address concerns regarding the paucity of long-term data following participation in mindfulness training, the use of heterogenous and unscalable interventions and restricted enrollment that hinders generalizability.
AHRQ-funded; HS026232.
Citation: Giordano NA, Swan BA, Johnson TM .
Scalable and sustainable approaches to address the well-being of healthcare personnel.
J Adv Nurs 2023 Feb; 79(2):e12-e15. doi: 10.1111/jan.15505..
Keywords: Burnout, Provider: Health Personnel, Stress
Apathy NC, Hare AJ, Fendrich S
I had not time to make it shorter: an exploratory analysis of how physicians reduce note length and time in notes.
The authors analyzed observed reductions in physicians’ note length and documentation time, both of which contribute to EHR burden and burnout. Their study used EHR metadata for ambulatory physician Epic users and examined changes in note composition of physicians who decreased note length and/or documentation time. Their findings showed that note length decreases were primarily attributable to reductions in copy/paste text and templated text, while note time decreases were primarily attributable to reductions in manual text. They concluded that future research should explore scalable burden-reduction initiatives that are responsive to both note bloat and documentation time.
AHRQ-funded; HS026116.
Citation: Apathy NC, Hare AJ, Fendrich S .
I had not time to make it shorter: an exploratory analysis of how physicians reduce note length and time in notes.
J Am Med Inform Assoc 2023 Jan18; 30(2):355-60. doi: 10.1093/jamia/ocac211..
Keywords: Provider: Physician, Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT)
Aiken LH, Sloane DM, McHugh MD
A repeated cross-sectional study of nurses immediately before and during the COVID-19 pandemic: Implications for action
The goal of this cross-sectional study was to establish whether hospital nursing care shortages are primarily due to the COVID pandemic, and therefore likely to subside, or if shortages are due to understaffing and poor working conditions that predated the pandemic. The study considered registered nurses in New York and Illinois, and a subset of staff nurses employed in 357 hospitals, before and during the pandemic. While no evidence was found to show that large numbers of nurses left in the first 18 months of the pandemic, the study’s findings indicate that nurses in hospitals with better staffing and more favorable work environments prior to the pandemic reported significantly better outcomes. The authors concluded that policies that prevent chronic understaffing have the most potential to stabilize the hospital nurse workforce.
AHRQ-funded; HS028978.
Citation: Aiken LH, Sloane DM, McHugh MD .
A repeated cross-sectional study of nurses immediately before and during the COVID-19 pandemic: Implications for action
Nurs Outlook 2023 Jan-Feb; 71(1):101903. doi: 10.1016/j.outlook.2022.11.007..
Keywords: COVID-19, Provider: Nurse, Workforce, Burnout
Campbell AM, Mattoni M, Yefimov MN
Improving cognitive workload in radiation therapists: a pilot EEG neurofeedback study.
The authors employed an accelerated alpha-theta neurofeedback (NF) protocol to test if 12 radiation therapy therapists (RTTs) could learn the protocol and exhibit behavior and brain performance-related benefits. Following the 3-week protocol, participants showed a decrease in subjective cognitive workload and a decrease in response time during a performance task, as well as a decrease in desynchrony of the alpha electroencephalogram band. The authors concluded that the RTTs successfully learned the protocol and improved in perceived cognitive workload following 3 weeks of neurofeedback.
AHRQ-funded; HS025597.
Citation: Campbell AM, Mattoni M, Yefimov MN .
Improving cognitive workload in radiation therapists: a pilot EEG neurofeedback study.
Front Psychol 2020 Dec 3;11:571739. doi: 10.3389/fpsyg.2020.571739..
Keywords: Provider, Burnout, Stress, Workforce
Smith JG, Rogowski JA, Lake ET
Missed care relates to nurse job enjoyment and intention to leave in neonatal intensive care.
Being unable to provide required nursing care to infants could contribute to poorer neonatal nurse job outcomes, which may exacerbate staffing challenges. Little evidence exists about how missed nursing care relates to neonatal nurse job outcomes. The purpose of this study was to determine relationships among missed nursing care, job enjoyment and intention to leave for neonatal nurses.
AHRQ-funded; HS024918.
Citation: Smith JG, Rogowski JA, Lake ET .
Missed care relates to nurse job enjoyment and intention to leave in neonatal intensive care.
J Nurs Manag 2020 Nov;28(8):1940-47. doi: 10.1111/jonm.12943..
Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Provider: Nurse, Provider, Burnout, Nursing
Womack DM, Hribar MR, Steege LM
Registered nurse strain detection using ambient data: an exploratory study of underutilized operational data streams in the hospital workplace.
Registered nurses (RNs) regularly adapt their work to ever-changing situations but routine adaptation transforms into RN strain when service demand exceeds staff capacity and patients are at risk of missed or delayed care. The purpose of this study was to assess the utility of ambient workplace data, defined as time-stamped transaction records and log file data produced by non-electronic health record care delivery tools (e.g., nurse call systems, communication devices), as an information channel for automated sensing of RN strain.
AHRQ-funded; HS026370.
Citation: Womack DM, Hribar MR, Steege LM .
Registered nurse strain detection using ambient data: an exploratory study of underutilized operational data streams in the hospital workplace.
Appl Clin Inform 2020 Aug;11(4):598-605. doi: 10.1055/s-0040-1715829..
Keywords: Provider: Nurse, Provider, Health Information Technology (HIT), Workforce, Burnout
Co Z, Holmgren AJ, Classen DC
The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support.
This study evaluated the overall performance of hospitals that used the Computerized Physician Order Entry Evaluation Tool in 2017 and 2018 and compared performances for fatal orders and nuisance orders each year. The authors evaluated 1599 hospitals that took the test by using their overall percentage scores along with the percentage of fatal orders appropriately alerted on and the percentage of nuisance orders incorrectly alerted on. Overall hospital scores improved from 58.1% in 2017 to 66.2% in 2018. Fatal order performance improved slightly from 78.8% to 83.0%, but there no very little change in nuisance order performance (89.0% to 89.7%). Conclusions were that perhaps hospitals are not targeting the deadliest orders first and some hospitals may be achieving higher scores by over-alerting. This has the potential to cause clinician burnout and even worsen patient safety.
AHRQ-funded; HS023696.
Citation: Co Z, Holmgren AJ, Classen DC .
The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support.
J Am Med Inform Assoc 2020 Aug;27(8):1252-58. doi: 10.1093/jamia/ocaa098..
Keywords: Medication: Safety, Medication, Patient Safety, Clinical Decision Support (CDS), Shared Decision Making, Burnout, Hospitals, Health Information Technology (HIT), Quality of Care
Poghosyan L, Ghaffari A, Liu J
Organizational support for nurse practitioners in primary care and workforce outcomes.
Lack of organizational support in healthcare settings has been linked to high levels of clinician stress, burnout, and job dissatisfaction. Little research exists on organizational support for nurse practitioners. In this study, the researchers investigated the relationship between organizational support and nurse practitioner outcomes, including job satisfaction, intent to leave, and quality of care. The investigators concluded that nurse practitioners from primary care practices with higher levels of organizational support were more likely to be satisfied with their jobs, have less intent to leave their jobs, and report better quality of care.
AHRQ-funded; HS024758.
Citation: Poghosyan L, Ghaffari A, Liu J .
Organizational support for nurse practitioners in primary care and workforce outcomes.
Nurs Res 2020 Jul/Aug;69(4):280-88. doi: 10.1097/nnr.0000000000000425..
Keywords: Provider: Clinician, Provider, Primary Care, Burnout, Stress, Workforce, Organizational Change
Bansal P, Bingemann TA, Greenhawt M
Clinician wellness during the COVID-19 pandemic: extraordinary times and unusual challenges for the allergist/immunologist.
This article describes current challenges for the allergy/immunology community due to the COVID-19 pandemic. The need for social distancing adds to complexity of care and can create isolation and anxiety. The authors suggests that tools such as the Strength-Focused and Meaning-Oriented Approach to Resilience and Transformation approach, wellness apps, mindfulness and gratitude can be used to help reduce issues contributing to burnout, depression, anxiety, substance abuse, and posttraumatic stress disorder.
AHRQ-funded; HS024599.
Citation: Bansal P, Bingemann TA, Greenhawt M .
Clinician wellness during the COVID-19 pandemic: extraordinary times and unusual challenges for the allergist/immunologist.
J Allergy Clin Immunol Pract 2020 Jun;8(6):1781-90.e3. doi: 10.1016/j.jaip.2020.04.001..
Keywords: COVID-19, Burnout, Stress, Provider: Clinician, Provider: Physician
Goldberg DG, Soylu TG, Grady VM
Indicators of workplace burnout among physicians, advanced practice clinicians, and staff in small to medium-sized primary care practices.
The goal of this study was to examine whether individual behaviors and attitudes towards major disruptive change has an effect on workplace burnout. Using surveys from healthcare professionals, researchers’ findings showed workplace burnout reported by 31.6% of physicians, 17.2% of advanced practice clinicians, 18.9% of clinical support staff, and 17.5% of administrative staff, with all healthcare professional groups having high levels of anxiety. Providers who experienced higher levels of anxiety and withdrawal were more than three times as likely to report burnout compared to those who experienced low levels in these domains.
AHRQ-funded; HS023913.
Citation: Goldberg DG, Soylu TG, Grady VM .
Indicators of workplace burnout among physicians, advanced practice clinicians, and staff in small to medium-sized primary care practices.
J Am Board Fam Med 2020 May-Jun;33(3):378-85. doi: 10.3122/jabfm.2020.03.190260..
Keywords: Burnout, Primary Care, Provider, Workflow, Workforce
Adler-Milstein J, Zhao W, Willard-Grace R
Electronic health records and burnout: time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians
This study examined whether objective measures of electronic health record (EHR) use-related to time, volume of work, and proficiency are associated with either exhaustion or cynicism. The authors combined Maslach Burnout Inventory survey measures with objective, vendor-defined EHR use measures from log files. Data was collected from all primary care clinics of a large, urban medical academic center in early 2018. One-third of clinicians had high cynicism and 51% had high emotional exhaustion. The clinicians with the most exhaustion spent time using the EHR after hours.
AHRQ-funded; HS022241.
Citation: Adler-Milstein J, Zhao W, Willard-Grace R .
Electronic health records and burnout: time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians
J Am Med Inform Assoc 2020 Apr;27(4):531-38. doi: 10.1093/jamia/ocz220..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Provider: Clinician, Provider: Physician, Provider, Primary Care
Corby S, Gold JA, Mohan V
A sociotechnical multiple perspectives approach to the use of medical scribes: a deeper dive into the scribe-provider interaction.
This study’s objective was examine the scribe-provider relationship at healthcare organizations. Scribes help providers with electronic health records to alleviate provider burnout and increase clinical efficiency. Participants in the study included 81 clinicians (30 providers, 27 scribes, and 24 administrators) across five sites. The analysis generated six subthemes: characteristics of an ideal scribe, characteristics of a good provider, provider variability, quality of the scribe-provider relationship, negative side of the relationship, and evaluation and supervision of scribes.
AHRQ-funded; HS025141.
Citation: Corby S, Gold JA, Mohan V .
A sociotechnical multiple perspectives approach to the use of medical scribes: a deeper dive into the scribe-provider interaction.
AMIA Annu Symp Proc 2020 Mar 4;2019:333-42..
Keywords: Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT)
White EM, Aiken LH, Sloane DM
Nursing home work environment, care quality, registered nurse burnout and job dissatisfaction.
The objective of this cross-sectional study was to examine the relationships between work environment, care quality, registered nurse (RN) burnout, and job dissatisfaction in nursing homes. In this study, the investigators linked 2015 RN4CAST-US nurse survey data with LTCfocus and Nursing Home Compare. They indicate that their results suggest that the work environment is an important area to target for interventions to improve care quality and nurse retention in nursing homes.
AHRQ-funded; HS000011.
Citation: White EM, Aiken LH, Sloane DM .
Nursing home work environment, care quality, registered nurse burnout and job dissatisfaction.
Geriatr Nurs 2020 Mar-Apr;41(2):158-64. doi: 10.1016/j.gerinurse.2019.08.007..
Keywords: Elderly, Nursing Homes, Burnout, Provider: Nurse, Provider, Quality of Care, Provider Performance