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Clinician burnout and its association with team based care in the Emergency Department

      Recent work has noted the alarming prevalence of clinician burnout among providers, particularly among acute care physicians [
      • Shanafelt T.D.
      • Boone S.
      • Tan L.
      • et al.
      Burnout and satisfaction with work-life balance among US physicians relative to the general US population.
      ]. Burnout is characterized by emotional exhaustion, physical fatigue, and cognitive weariness, which may lead to feelings of depersonalization and reduced accomplishment [
      • Maslach C.
      • Jackson S.E.
      • Leiter M.P.
      • Schaufeli W.B.
      • Schwab R.L.
      Maslach burnout inventory.
      ]. The consequences of burnout are broad and has been shown to adversely influence both clinician well-being and patient care outcomes [
      • Chang B.P.
      • Carter E.
      • Ng N.
      • Flynn C.
      • Tan T.
      Association of clinician burnout and perceived clinician-patient communication.
      ,
      • Lenzenweger M.F.
      • Nakayama K.
      • Chang B.P.
      Methodological excursions in pursuit of a somatosensory dysfunction in schizotypy and schizophrenia.
      ]. An emerging body of literature has found that aspects of the acute care environment may play a role in moderating the effects of burnout among emergency providers. Factors such as Emergency Department (ED) crowding, hallway care, and patient volume has been associated with increased perceived psychological distress and perceived communication quality among patients and providers in the ED setting [
      • Homma K.
      • Chang B.
      • Shaffer J.
      • et al.
      Association of social support during emergency department evaluation for acute coronary syndrome with subsequent posttraumatic stress symptoms.
      ,
      • Meli L.
      • Alcántara C.
      • Sumner J.
      • Swan B.
      • Chang B.
      • Edmondson D.
      Enduring somatic threat perceptions and post-traumatic stress disorder symptoms in survivors of cardiac events.
      ,
      • Chang B.P.
      • Carter E.
      • Suh E.H.
      • Kronish I.M.
      • Edmondson D.
      Patient treatment in emergency department hallways and patient perception of clinician-patient communication.
      ]. One aspect of the ED environment which may also influence the development of burnout may be the team structure and staff environment in which clinicians operate. The ED is a fast-paced setting, where teamwork is critical to efficient care. While coordinated team based models (e.g. physician, nurse and ancillary staff paired together) have been associated with improvements in specific disease processes such as trauma and cardiac arrest, [
      • Hillman K.
      • Parr M.
      • Flabouris A.
      • Bishop G.
      • Stewart A.
      Redefining in-hospital resuscitation: the concept of the medical emergency team.
      ] less is known regarding such team models on clinician based psychological outcomes such as clinician burnout. Past work has found that team structure and workplace culture may play a role in the development of burnout in healthcare settings, [
      • Willard-Grace R.
      • Hessler D.
      • Rogers E.
      • Dubé K.
      • Bodenheimer T.
      • Grumbach K.
      Team structure and culture are associated with lower burnout in primary care.
      ] though this work has not previously been explored in the acute care setting. The goal of our study was to evaluate if a novel ED team based structure would be associated with decreased levels of clinician burnout.

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        Association of clinician burnout and perceived clinician-patient communication.
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        Methodological excursions in pursuit of a somatosensory dysfunction in schizotypy and schizophrenia.
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