Exploring the association between clinician burnout and adherence to back pain evaluation and treatment guidelines in the emergency department of an urban safety-net hospital

Burnout among physicians has been associated with self-reported lower quality of care. To examine the relationship between burnout and objectively assessed quality of care, we examined adherence to best practices for acute back pain imaging and opioid prescribing in patients presenting with back pai...

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Main Author: Lerner, Amanda
Other Authors: Drainoni, Mari-Lynn
Language:en_US
Published: 2018
Subjects:
Online Access:https://hdl.handle.net/2144/32692
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spelling ndltd-bu.edu-oai-open.bu.edu-2144-326922019-01-08T15:44:56Z Exploring the association between clinician burnout and adherence to back pain evaluation and treatment guidelines in the emergency department of an urban safety-net hospital Lerner, Amanda Drainoni, Mari-Lynn Health sciences Burnout among physicians has been associated with self-reported lower quality of care. To examine the relationship between burnout and objectively assessed quality of care, we examined adherence to best practices for acute back pain imaging and opioid prescribing in patients presenting with back pain to an Emergency Department (ED). We surveyed clinicians who provide care in the urgent care section of a large, urban hospital’s ED, from May-June 2017. Burnout was dichotomized using a validated single burnout item measure on the Mini-Z survey. We extracted data, 3 months pre- and post-survey date, from the electronic medical records of patients with the chief complaint of back pain who were cared for by the study providers. We had two primary outcomes: 1. Proportion of patients with opioid medication ordered during the visit and/or prescribed on discharge. 2. Proportion of patients in whom spinal imaging was ordered. We examined the association between burnout and the primary outcomes in unadjusted and adjusted analyses using logistic regression, controlling for patient age, sex, race/ethnicity, and history of depression, anxiety, or substance use. 31 (97% of eligible) providers completed the survey. Burnout was present in 20%. Of 1,337 unique ED visits for back pain, 4% of patients received opioids and 9% received imaging. None of the outcome measures showed statistically significant differences between providers who reported burnout and those who did not in either unadjusted or adjusted models. Compared to providers who did not report burnout, providers who reported burnout were no less likely to prescribe opioids while the patient was in the ED (adjusted odds ratio (AOR): 0.86, 95% confidence interval (CI) 0.33 to 2.21) nor upon discharge (AOR: 0.51, 95% CI 0.07 to 4.02), and no less likely to order diagnostic imaging (AOR: 0.94, 95% CI 0.32 to 2.73). We did not identify an association between provider burnout and adherence to guidelines for back pain care with respect to imaging or opioid prescribing; however, both were relatively uncommon in this ED. Further research in provider burnout utilizing objective outcomes is important to understand the impact of burnout on quality of care. 2020-10-23T00:00:00Z 2018-11-26T18:39:30Z 2018 2018-10-23T22:01:26Z Thesis/Dissertation https://hdl.handle.net/2144/32692 en_US
collection NDLTD
language en_US
sources NDLTD
topic Health sciences
spellingShingle Health sciences
Lerner, Amanda
Exploring the association between clinician burnout and adherence to back pain evaluation and treatment guidelines in the emergency department of an urban safety-net hospital
description Burnout among physicians has been associated with self-reported lower quality of care. To examine the relationship between burnout and objectively assessed quality of care, we examined adherence to best practices for acute back pain imaging and opioid prescribing in patients presenting with back pain to an Emergency Department (ED). We surveyed clinicians who provide care in the urgent care section of a large, urban hospital’s ED, from May-June 2017. Burnout was dichotomized using a validated single burnout item measure on the Mini-Z survey. We extracted data, 3 months pre- and post-survey date, from the electronic medical records of patients with the chief complaint of back pain who were cared for by the study providers. We had two primary outcomes: 1. Proportion of patients with opioid medication ordered during the visit and/or prescribed on discharge. 2. Proportion of patients in whom spinal imaging was ordered. We examined the association between burnout and the primary outcomes in unadjusted and adjusted analyses using logistic regression, controlling for patient age, sex, race/ethnicity, and history of depression, anxiety, or substance use. 31 (97% of eligible) providers completed the survey. Burnout was present in 20%. Of 1,337 unique ED visits for back pain, 4% of patients received opioids and 9% received imaging. None of the outcome measures showed statistically significant differences between providers who reported burnout and those who did not in either unadjusted or adjusted models. Compared to providers who did not report burnout, providers who reported burnout were no less likely to prescribe opioids while the patient was in the ED (adjusted odds ratio (AOR): 0.86, 95% confidence interval (CI) 0.33 to 2.21) nor upon discharge (AOR: 0.51, 95% CI 0.07 to 4.02), and no less likely to order diagnostic imaging (AOR: 0.94, 95% CI 0.32 to 2.73). We did not identify an association between provider burnout and adherence to guidelines for back pain care with respect to imaging or opioid prescribing; however, both were relatively uncommon in this ED. Further research in provider burnout utilizing objective outcomes is important to understand the impact of burnout on quality of care. === 2020-10-23T00:00:00Z
author2 Drainoni, Mari-Lynn
author_facet Drainoni, Mari-Lynn
Lerner, Amanda
author Lerner, Amanda
author_sort Lerner, Amanda
title Exploring the association between clinician burnout and adherence to back pain evaluation and treatment guidelines in the emergency department of an urban safety-net hospital
title_short Exploring the association between clinician burnout and adherence to back pain evaluation and treatment guidelines in the emergency department of an urban safety-net hospital
title_full Exploring the association between clinician burnout and adherence to back pain evaluation and treatment guidelines in the emergency department of an urban safety-net hospital
title_fullStr Exploring the association between clinician burnout and adherence to back pain evaluation and treatment guidelines in the emergency department of an urban safety-net hospital
title_full_unstemmed Exploring the association between clinician burnout and adherence to back pain evaluation and treatment guidelines in the emergency department of an urban safety-net hospital
title_sort exploring the association between clinician burnout and adherence to back pain evaluation and treatment guidelines in the emergency department of an urban safety-net hospital
publishDate 2018
url https://hdl.handle.net/2144/32692
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