Physician burnout has been a huge focus for healthcare provider organizations since before the pandemic – but the pandemic intensified the problem.

Dr. Brian Patel knows this all too well. Patel is senior vice president for medical affairs, medical director and chief quality officer at Sturdy Memorial Hospital in Attleboro, Massachusetts. And he's been working to stem the problem of physician burnout.

For 2023, he has three major priorities on the issue: addressing workplace violence, curbing emergency department utilization, and picking the right tools to work smarter, not harder. And data and health IT have a big part to play.

Healthcare IT News sat down with Patel to glean strategy to share with executives and clinicians at other hospitals and health systems.

Q. Among your thoughts on helping reduce healthcare worker burnout, you suggest healthcare provider organizations need to address workplace violence. Please talk a bit about the environment and what organizations can do to diminish this problem.

A. Even before the pandemic, half of emergency department physicians and 70% of ED nurses reported they had been hit or kicked on the job. Now, 85% of ED physicians say they’ve been subjected to workplace violence – and seven out of 10 ED workers say workplace violence is a key contributor to burnout.

In 2020, an incident of abuse toward a healthcare worker took place every 57 minutes. In 2021, it increased to every 49 minutes. In 2022, the incidents increased to once every 38 minutes.

Physicians and nurses didn’t go into medicine to be yelled at, kicked, bit or punched by their patients.

Yet every day, increasing volumes of patients coupled with increased boarding of medical and behavioral health patients lead to delays in care, staffing shortages and a rise in conditions that contribute to volatility at the point of care that put their lives and their welfare at risk.

And unfortunately, it’s a problem that has become worse throughout the pandemic.

We must invest in the tools needed to anticipate the potential for violence at the point of care, including in the ED, based on a patient’s medical history and current and past behaviors. Healthcare organizations also must take a firm stand on workplace violence – one that is backed by action.

This is an area where Sturdy Memorial Hospital, a 149-bed community hospital that records 50,000 ED visits a year, is taking action.

Our approach to real-time threat assessment in the ED helps prevent workplace violence before it occurs and powers a more tightly coordinated response. We established a Threat Assessment Team with professionals from across disciplines to review cases and develop ways to notify staff of a patient’s risk for violence once they arrive to the ED.

This approach is especially valuable in the ED and ICU, where the risk of vulnerability is higher due to the pressures patients face and their medical conditions.

Additionally, we have provided mechanisms for staff to identify patients at risk of violence in a way that all members of the care team are aware of this risk anytime they interact with the patient, and can protect themselves accordingly.

We've also partnered with PointClickCare, a healthcare information technology platform vendor that integrates with our EHR to better identify patients with the potential to exhibit violence, including those who have exhibited violence in the past.

The impact has been dramatic. Our work has decreased violent encounters in the ED and ICU and gives staff greater confidence that the right precautions are in place to protect themselves and those they serve.

Q. You say curbing emergency department utilization will help reduce burnout. How, and how can provider organizations accomplish this feat?

A. Amid the pandemic, one out of five patients with a serious illness struggled to access care, including mental healthcare. This is occurring at a time when mental health conditions and symptom severity are rising and mental health professionals are struggling to keep up with the surge in patients.

Many of these individuals end up in the ED, an area of care that is not designed to treat mental illness – and it’s putting ED professionals’ physical and mental health at risk.

In this environment, the pressures of providing care in an emergency environment run deep. Last year, 47% of physicians reported feelings of burnout, up 5% since 2020. Meanwhile, one-third of nurses plan to leave their jobs – and 44% blame burnout and stress for the desire to quit.

To help ease the burden on ED staff across the country, healthcare organizations must proactively address the complex needs of high ED utilizers, from behavioral health conditions to social determinants of health.

This will take a tightly coordinated approach that leverages data and care collaboration tools. At Sturdy Memorial, a unique approach to identifying high ED utilizers with behavioral health conditions and SDOH has reduced ED use in this population by 45%.

By reducing ED utilization, patients are getting the care they need in the right settings and ED providers feel that the patients they are caring for are actually getting the right care rather than returning to the ED repeatedly for the same clinical issues.

A large part of burnout for providers in this situation is the perception that they can’t provide these patients the definitive care they need causing them to return repeatedly to the ED which results in increased frustrations for the patient, as well as the care team.

To address ED utilization, we start by leveraging real-time notifications pushed directly into the EHR to rapidly identify behavioral health patients with more than three ED visits in the past six months, including at other hospitals.

When these patients are flagged, our team coordinates efforts with a local behavioral health provider, Community Counseling of Bristol County, to assign patients to a dedicated case manager with behavioral health expertise. From there, patients are connected with outpatient programs that can help address their mental health needs.

Case managers also work to identify and address the SDOH factors – such as homelessness and transportation barriers – that often contribute to high ED utilization.

Today, unnecessary ED utilization by individuals with behavioral health challenges who are managed through this program remains 44% lower than the six-month period prior to entering the program. And, because the program also addresses SDOH, patients not only receive better care, but also gain connections to resources that help meet their whole health needs, from healthy food to transportation or safe shelter.

Q. You've said that successful care teams in 2023 will continue to leverage the right tools to smarter with the limited staff they have – this includes health IT tools. What is needed? Where should provider organizations invest?

A. Physicians and care teams are stretched thinner than ever. In 2022, the American Hospital Association called the workforce shortage a “national emergency,” projecting the overall shortage of nurses would reach 1.1 million by the end of 2022.

Meanwhile, 46% of nurses say they are being floated or reassigned to other clinical care units without receiving the education they need to prepare. It’s a situation that creates unsafe working conditions for physicians and clinicians – and an unsafe care environment for patients and their families.

In 2023, successful care teams will continue to leverage the right tools to work smarter with the limited staff they have. This includes health IT tools that leverage data to deliver actionable insights at the point of care – allowing existing staff to make more-informed decisions on the best plan of action for their patients.

Additionally, investing in tools that better improve efficient, easily accessible healthcare information across care locations, agnostic to the individual organizations' EHR platforms, will allow better coordinated, timely care for patients, with use of less human resources.

Utilizing IT tools to improve care coordination and improved solutions to address social determinants of health will help reduce ED utilization, readmissions and length of stay – all of which results in improved ability to care for patients with less staff needed.

Tools that enable meaningful collaboration and access to real‐time insights at any stage of a patient’s healthcare journey – such as an ADT-based care collaboration network capable of delivering real-time alerts about patient vulnerabilities – strengthen quality of care.

They also improve outcomes for patients while giving staff the insight needed to support more effective, safer care encounters. In 2023, leading organizations will lean into these types of tools to deliver smarter care with limited staff while protecting team members’ wellbeing.

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Email the writer: bsiwicki@himss.org
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