298 Factors Associated With Provider Shift Experience in an Academic Pediatric Emergency Department: A Novel Shift Satisfaction Score

Abstract

Physician wellness is a multi-faceted construct involving engagement, fulfillment, and the absence of distress and burnout. While physician burnout negatively affects patient care, job satisfaction correlates with higher patient experience scores and is one subcategory of wellness linked to resource factors, clerical workload, efficiency, relationships, and control. This study focused on the intersection of provider satisfaction and the clinical work environment in the emergency department (ED). The objective was to use a novel shift satisfaction score to identify common themes impacting the on-shift wellness and experience of pediatric emergency medicine (PEM) providers. This descriptive study used an anonymous, electronic survey instrument with two questions developed via a modified Delphi method. Q1: Overall, how satisfied are you with your shift today? This was rated on a 7-point Likert scale. Q2: What are the main factors that you considered when rating your level of satisfaction with your shift today? This was an open-ended response. A voluntary response sampling of PEM workers (physicians, fellows, residents, nurses, and staff) at an academic pediatric trauma center was recruited via email listservs and QR codes at ED workstations. Data were collected and managed in REDCap and Excel. Qualitative analysis using inductive thematic coding was performed. Quantitative analysis with chi-squared testing to determine theme association with shift satisfaction employed a top-two-box model for binary outcomes. Univariate logistic regression was used to determine association of shift satisfaction with role. From Oct 2020 to May 2021, 372 unique responses were collected and analyzed. 250 respondents reported satisfaction on shift, while 120 respondents reported dissatisfaction. Physicians (OR 1.72, p=0.037) and paramedic/techs (OR 1.94, p=0.076) were associated with higher shift satisfaction than nurses, although only physicians reached significance. Themes related to teamwork, teaching/learning, and no comment were positively and significantly associated with higher shift satisfaction scores (score 6-7). Themes related to external team interactions (consultants, admitting teams), equipment/stocking, staffing, acuity/complex patients, code alert/death, and personal reasons were negatively and significantly associated with lower shift satisfaction scores (score 1-3). This pilot study identified work environment factors impacting provider shift satisfaction in a pediatric ED. Our findings imply that instituting practices that encourage quality team interactions, camaraderie, and opportunities for teaching and learning could positively impact satisfaction and wellness. In addition, attention to work environment improvements, such as staffing ratios and stocking issues, could mitigate on-shift dissatisfaction. Further, shift satisfaction level data can guide future research examining correlations with other operational dashboard metrics and provider-based interventions.