NICU provider burnout linked to multiple organizational factors

1. Neonatal intensive care units (NICUs) with higher average admission rates and longstanding electronic health record (EHR) usage were found to have significantly higher provider burnout prevalence than those with lower admit rates and no EHR usage.     

Study Rundown: Burnout is a condition characterized by fatigue, detachment, and cynicism attributed to sustained levels of stress. In the critical care setting, burnout may be driven by the emotional challenges of providing care to medically complex and acutely ill patients. In this cross-sectional study, researchers aimed to characterize the relationship between provider burnout and organizational factors in California-based NICUs by using the Maslach Burnout Inventory (MBI), a well-known self-report survey used to assess burnout. Results showed that burnout prevalence was significantly associated with higher average daily admission rates and longstanding EHR usage. Factors that were not significantly associated with higher burnout rate included patient mortality risk, the proportion of high risk patients (i.e. birth weight between 401-1600g or gestational age between 22 0/7 and 29 6/7 weeks), presence of an in-house attending, and presence of a NICU within a teaching institution. Data suggested that both large NICU size and longstanding EHR usage may limit providers’ interpersonal interactions with patients and their families. However, this study used emotional exhaustion as a surrogate for burnout. Other limitations to consider include response bias and the potential lack of generalizability beyond Californian NICUs. Overall, this study identifies new organizational determinants of NICU provider burnout that may be targeted for intervention or further study in future research.

Click to read the study, published today in Pediatrics

Relevant Reading: Burnout in the NICU setting and its relation to safety culture

Study Author, Dr. Daniel Tawfik, MD, talks to 2 Minute Medicine: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.

“This study highlights the association between large, busy patient care units and provider burnout, as well as an independent association with electronic health record use. Medical trainees are concentrated in these suspected high-risk environments for burnout, and this study may serve as an impetus for them to learn to identify the symptoms of burnout and identify resources for combatting burnout within their institutions.”

In-Depth [cross-sectional study]: In this study, researchers evaluated the relationship between organizational factors of NICUs and response data from a larger survey on safety culture obtained from NICUs affiliated with the California Perinatal Quality Care Collaborative. Out of 130 member hospitals, 41 NICUs and 1934 associated providers participated in this study, with individual units caring for 84 to 2906 neonates during the study period (Jan 1, 2011 to Dec 31, 2012). Burnout was assessed using the 4-question emotional exhaustion questionnaire of the MBI. Medical providers were included if they had a ≥0.5 full-time commitment to the NICU for ≥4 consecutive weeks before survey administration. Organizational factors evaluated in multivariable analysis that were significantly and positively associated with higher burnout prevalence included average daily admissions (mean = 1.3 ± 0.8, SE = 1.42; p < 0.001), EHR use (n = 30 [80%], SE = 1.50, p < 0.03). Of note, NICUs with longstanding EHRs did not differ significantly in average daily admissions or number of licensed beds. In univariable analyses, admission rates, number of licensed beds, average lengths of stay, EHR use, and regional California Childrens’ Services level were significantly associated with higher burnout prevalence.

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