Center for AI, Research, and Evaluation, IBM Watson Health, Cambridge, Massachusetts, USA.
Vanderbilt University Medical Center, Nashville, Tennessee, USA.
J Am Med Inform Assoc. 2021 Apr 23;28(5):985-997. doi: 10.1093/jamia/ocaa301.
To conduct a systematic review identifying workplace interventions that mitigate physician burnout related to the digital environment including health information technologies (eg, electronic health records) and decision support systems) with or without the application of advanced analytics for clinical care.
Literature published from January 1, 2007 to June 3, 2020 was systematically reviewed from multiple databases and hand searches. Subgroup analysis identified relevant physician burnout studies with interventions examining digital tool burden, related workflow inefficiencies, and measures of burnout, stress, or job satisfaction in all practice settings.
The search strategy identified 4806 citations of which 81 met inclusion criteria. Thirty-eight studies reported interventions to decrease digital tool burden. Sixty-eight percent of these studies reported improvement in burnout and/or its proxy measures. Burnout was decreased by interventions that optimized technologies (primarily electronic health records), provided training, reduced documentation and task time, expanded the care team, and leveraged quality improvement processes in workflows.
The contribution of digital tools to physician burnout can be mitigated by careful examination of usability, introducing technologies to save or optimize time, and applying quality improvement to workflows.
Physician burnout is not reduced by technology implementation but can be mitigated by technology and workflow optimization, training, team expansion, and careful consideration of factors affecting burnout, including specialty, practice setting, regulatory pressures, and how physicians spend their time.
系统回顾识别减轻与数字环境相关的医生倦怠的工作场所干预措施，包括健康信息技术（如电子健康记录）和决策支持系统），无论是否应用先进的分析技术用于临床护理。
从 2007 年 1 月 1 日至 2020 年 6 月 3 日，从多个数据库和手工检索中系统地回顾了已发表的文献。亚组分析确定了相关的医生倦怠研究，干预措施检查了数字工具负担、相关工作流程效率低下以及所有实践环境中的倦怠、压力或工作满意度衡量标准。
搜索策略确定了 4806 条引文，其中 81 条符合纳入标准。38 项研究报告了减少数字工具负担的干预措施。这些研究中有 68%报告了倦怠及其替代指标的改善。通过优化技术（主要是电子健康记录）、提供培训、减少文档和任务时间、扩大护理团队以及利用工作流程中的质量改进过程来干预，可以减少倦怠。
通过仔细检查可用性、引入节省或优化时间的技术以及将质量改进应用于工作流程，可以减轻数字工具对医生倦怠的影响。
技术实施不会减轻医生倦怠，但可以通过技术和工作流程优化、培训、团队扩展以及仔细考虑影响倦怠的因素（包括专业、实践环境、监管压力以及医生如何分配时间）来减轻。
