Hospitals must recognize burnout in emergency rooms

Emergency doctors regularly report high levels of stress and burnout.

Surveys of doctors from Medscape have found nearly two out of three emergency physicians reporting symptoms of burnout, the highest of any specialty.

Dr. Randy Katz, district medical director of emergency services of the Memorial Healthcare System in Florida, tells Chief Healthcare Executive® that there are a host of factors contributing to burnout in emergency doctors and nurses.

He says it’s imperative for hospitals and health systems to pay attention to what’s happening in the emergency department.

“This is the front door to your hospital,” he says. “In some hospitals, 80-90% of the patients upstairs come through the emergency department. We touch almost every patient in every department, and I think for the security and viability of your health care system, you do need to look at what's going on in your department with respect to burnout and attrition, and, just the overall well-being of your physicians, nurses and clinicians that work in the department. It's imperative to your existence.”

Patients also are waiting for longer periods in the emergency room before they can get a bed in a room, waiting hours or days, hospital officials say.

Katz says the problem, often called boarding in the emergency room, places added stress on doctors and nurses.

“When we talk about what makes the job so difficult, and that's just one of the components of the disease, but boarding, for us, is a major challenge,” he says.

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Risks of turnover

Burnout leads to greater risk of turnover, Katz notes.

At Memorial Healthcare System, turnover is about 8% annually, which he notes is better than some systems. But he says staffing is a challenge in emergency medicine.

“Turnover is one of the things that will kill an emergency department, especially high turnover rates,” he says.

“You can’t build a culture and you can’t really build a sustainable department if you don't have a workforce that's there to work with, … If there's constant turnover, it becomes very difficult,” he adds.

Katz says there is more awareness of burnout in the emergency department. But there are competing demands, including those from insurance companies and government programs that put more stress on doctors and nurses.

“The solutions are not easy solutions,” Katz says. “So I do think there's more recognition, but less has been done about solving the problem.”

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Hitting the road

The Memorial Healthcare System has taken some novel steps to help those in the emergency department stay healthy.

The system engages emergency department staff in fitness activities, including a running club. Katz, who is passionate about running, and others in the system have run in local races in Florida. Doctors and nurses have also worked with a local group supporting individuals with disabilities, with staff pushing those in wheelchairs.

Doctors and nurses also use an app to track physical activity, with winners named each quarter. Katz says the exercise-oriented efforts pay dividends.

“It's a very physical job,” he says. “And, you know, we're working long hours, sometimes, nights, weekends. Sleep patterns are a little disrupted, but we’re really trying to pay attention to the health component, one thing we do have some control over.”

While people can work out on their own, Katz also says there’s value in doctors, nurses and other staff members supporting each other. A couple of nurses will say they are going for a run, and they’ll encourage others to join.

It offers a little more incentive, and others are motivated to join, he says..

“You have other people that are there to support you, and you kind of need to show up for them,” Katz says.

“It's not easy to show up on your own and have that type of self-discipline every day when you're tired and when you've worked a night shift, but if you know you've committed to a group and they're out there on the weekend and they're telling you … ‘Hey, we're going to be here,’ you feel more compelled to show up,” he says.

Even as the health system encourages clinicians to get their exercise, Katz says there is an understanding of the need for breaks during shifts in the emergency department.

Katz says emergency nurses in the system are given some time for meal breaks and to step away, at least briefly.

“I think with nursing, we're pretty vigilant about making sure they get their time off,” he says.

With emergency physicians, Katz says there is a similar push to take a break to get a quick bite, but he says it’s not always feasible.

“You don't always have that luxury as a physician,” Katz says. “So I do think we try and make sure that physicians take some time off during the day to eat lunch, but I will say there are days when you're eating at your desk while you're working, because you just don't have the ability to pick up and, you know, take a breather and walk away from a bunch of sick patients. It's not always possible, which is the challenge of the job.”