An Innovative Approach to Improve Communication and Reduce Physician Stress and Burnout in a University Affiliated Residency Program

Abstract

Ineffective communication between nursing staff and residents leads to numerous educational and patient-care interruptions, increasing resident stress and overall workload. We developed an innovative and simple, secure electronic health record (EHR) base text paging system to communicate with internal medicine residents. The goal is to avoid unnecessary interruption during patient care or educational activities and reduce stress. Traditional paging system can send a phone number to call back. We developed and implemented a HIPPA-compliant, EHR-integrated text paging at a busy 591-bed urban hospital. Access was granted to unit clerks, nursing staff, case managers, and physicians. Senders could either send a traditional telephone number page or a text page through our EHR. The recipient could then either acknowledge receipt of the page or take appropriate actions. Afterward, Internal medicine residents were polled on overall satisfaction difference between basic phone based numeric paging and the enhanced EHR text paging system. Educational interruptions (averaging over 7 pages) decreased from 64% to 16%. Patient care interruptions fell from 68% to 12%. 88% of residents felt that 50% or less of the pages were non-emergent and did not require an immediate action. 92% of 25 surveyed internal medicine residents preferred text paging over numeric paging and responded through the EHR 60% of the time by placing direct orders. Time savings using the new system over a 3-month span amounted to 72.5 h in transmission time alone. Text paging among medical caregivers and internal medicine residents through EHR-associated communication reduced patient care and educational interruptions. It saved time spent sending pages, answering unnecessary pages and it improved resident's subjective stress and satisfaction levels.

Implementation of an Electronic Health Record–Based Messaging System in the Emergency Department: Effects on Physician Workflow and Resident Burnout

“…Similar studies found the EHR messaging system to improve resident's stress and satisfaction levels. 1 We did see a slight trend in improvement, but our results were not statistically significant. We believe that burnout is a complex topic with multiple factors and that decreasing the number of interruptions might not be enough to significantly decrease physician burnout to cause a statistically significant result.…”

“…Evolving technological advances have proven to be an intricate part of health care interdisciplinary communication systems. Ineffective communication between nursing staff and residents or physicians leads to numerous educational and patient care interruptions, increasing stress and overall workload 1 . Studies have shown that lack of control over work organization is one of the stressors for residents that may contribute to burnout 2 .…”

“…Ineffective communication between nursing staff and residents or physicians leads to numerous educational and patient care interruptions, increasing stress and overall workload. 1 Studies have shown that lack of control over work organization is one of the stressors for residents that may contribute to burnout. 2 Frequent interruptions in workflow are associated with increased workplace stress and risk for detrimental clinical errors.…”

Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systematic Review

“…64e68 All 3 studies with interventions evaluating EHR improvements significantly improved satisfaction and decreased stress (Table 2). 64,65,67 With the exception of Menachemi et al, 66 interventions of EHR implementation in a workflow generally worsened or had no effect on burnout or its indicators. 59,60,63,66,68 Trends identified within these studies included perceived insufficient training contributed to EHR ineffectiveness; EHR use by the physician within clinic visits negatively impacted patient-centered communication; and physician characteristics associated with less satisfaction included older age (>55 years), male sex, and surgical specialties.…”

I’m Not Good for Anything and That’s Why I’m Stressed: Analysis of the Effect of Self-Efficacy and Emotional Intelligence on Student Stress Using SEM and QCA

“…Despite the importance of stress in the lives of individuals (Moore et al, 2016) and specifically in the case of university students (Lapointe et al, 2018), and the role played by EI as well as self-efficacy in the said stress, few studies have simultaneously analyzed the role played by both aspects as regard stress (Aguilar et al, 2014). In response to this, the present research aims to determine the role played by self-efficacy and EI over perceived stress.…”