ABSTRACT
Study Objectives: To understand how the emergency department built environment contributes to physician burnout. Methods: We conducted semi-structured interviews of attending physicians who work regularly at the study institution, an urban ED, Level 1 Trauma Center with an annual census of 85, 000 and an EM residency program. Physicians were first asked about overall burnout followed by questions relating the physical environment to burnout. Subjects participated in a virtual reality (VR) simulation of the study ED. In the VR simulation, subjects placed virtual “sticky notes” to describe elements of the environment that contributed to or relieved burnout. Physicians also completed occupant comfort surveys to measure their overall satisfaction with the built environment for three different ED spaces. The surveys contained prompts for 6 categories: acoustics, air quality, cleanliness and maintenance, lighting, layout and furnishings, temperature (photo). A modified grounded theory approach was used to analyze interview transcripts, VR collected virtual memos and surveys. Results: 19 emergency physicians were enrolled (68% male, 42% early-, 42% mid-, 16% late-career) Average Maslach Burnout Inventory scores were 2.8 for emotional exhaustion, 2.4 for depersonalization and 4.8 for personal accomplishment. Sources of overall ED burnout were most commonly attributed to to ED volume, crowding, lack of resources, lack of institutional support, provider metrics, difficult patients, medico-legal concerns, worsening job market and effects of COVID-19. For the main study question, 71 themes were coded over 6 built environment domains and 25 themes related to impact and burnout. Of the 6 environmental domains, layout, cleanliness and acoustics were more commonly associated with burnout compared to air quality, lighting and temperature. An internal waiting room was the strongest contributor to physician burnout due to the close proximity to unassigned (waiting) patients associated with interruptions, distractions and concern for provider safety which contributed to emotional exhaustion and depersonalization. Increased distance to patient rooms was connected with a sense of depersonalization. Clutter, non-useful displays, poor organization and equipment issues were frequently noted and connected to a sense of disorganization and decreased personal accomplishment. Additionally, poor visualization of patients and monitors from physician workstations contributed to decreased situational awareness, anxiety, lack of provider safety and decreased personal accomplishment. Other frequently cited components included lack of visual/acoustical privacy in hallways, patient proximity to physician workstations associated with patient discomfort, medico-legal concerns, emotional exhaustion and depersonalization. 100% of the physicians agreed or strongly agreed that the VR simulation was helpful to elicit memories and reflection about the built environment. Conclusion: The study reflects associations between the ED built environment and components of physician burnout. Interventions aimed at balancing distance to patients (unassigned and assigned), reducing clutter and disorganization, balancing the acoustical environment and improving patient comfort and privacy may improve provider wellness. [Formula presented]