Exploring the association between clinician burnout and adherence to back pain evaluation and treatment guidelines in the emergency department of an urban safety-net hospital
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Burnout among physicians has been associated with self-reported lower quality of care. To examine the relationship between burnout and objectively assessed quality of care, we examined adherence to best practices for acute back pain imaging and opioid prescribing in patients presenting with back pain to an Emergency Department (ED). We surveyed clinicians who provide care in the urgent care section of a large, urban hospital’s ED, from May-June 2017. Burnout was dichotomized using a validated single burnout item measure on the Mini-Z survey. We extracted data, 3 months pre- and post-survey date, from the electronic medical records of patients with the chief complaint of back pain who were cared for by the study providers. We had two primary outcomes: 1. Proportion of patients with opioid medication ordered during the visit and/or prescribed on discharge. 2. Proportion of patients in whom spinal imaging was ordered. We examined the association between burnout and the primary outcomes in unadjusted and adjusted analyses using logistic regression, controlling for patient age, sex, race/ethnicity, and history of depression, anxiety, or substance use. 31 (97% of eligible) providers completed the survey. Burnout was present in 20%. Of 1,337 unique ED visits for back pain, 4% of patients received opioids and 9% received imaging. None of the outcome measures showed statistically significant differences between providers who reported burnout and those who did not in either unadjusted or adjusted models. Compared to providers who did not report burnout, providers who reported burnout were no less likely to prescribe opioids while the patient was in the ED (adjusted odds ratio (AOR): 0.86, 95% confidence interval (CI) 0.33 to 2.21) nor upon discharge (AOR: 0.51, 95% CI 0.07 to 4.02), and no less likely to order diagnostic imaging (AOR: 0.94, 95% CI 0.32 to 2.73). We did not identify an association between provider burnout and adherence to guidelines for back pain care with respect to imaging or opioid prescribing; however, both were relatively uncommon in this ED. Further research in provider burnout utilizing objective outcomes is important to understand the impact of burnout on quality of care.