Subramony Rachna, Gieschen Josh, Kreshak Allyson, Tolia Vaishal, Minns Alicia
Department of Emergency Medicine, UCSD, San Diego, California.
Fourth-Year Medical Student, UC San Diego, La Jolla, California.
J Emerg Med. 2025 Jul;74:134-141. doi: 10.1016/j.jemermed.2025.03.008. Epub 2025 Mar 19.
Given that the 2020s have seen record levels of physician burnout, there is a pressing need to develop solutions to combat this trend.
In this study we aimed to assess the efficacy of flow facilitators as an intervention to improve physician well-being in the emergency department (ED). A novel position in the ED was established and its impact on physician well-being assessed.
Emergency physicians at a large academic hospital were surveyed anonymously and met to discuss the factors affecting well-being and job satisfaction. Based on this meeting and survey results, the hospital system hired three full-time employees to function as "flow facilitators," with their primary task to streamline logistical challenges in the ED, with the goal of decreasing wait times and increasing physician satisfaction. Emergency physicians were then surveyed to evaluate the changes in their self-reported satisfaction after implementation of an ED flow facilitator. Objective metrics of patient satisfaction and favorable outcomes (left-without-being-seen rates/wait times) were also assessed, as well as identifying specific areas for further improvement by the existing flow facilitators.
Physicians overwhelmingly responded positively to the program, with the most consistent positive responses directed toward perceived improvement in logistical challenges over clinical challenges. Over 85% of physicians agreed that the program had improved their overall well-being. The specific throughput metrics showed that for computed tomography, ultrasound, and X-ray study, the time for order placed to results obtained decreased significantly. There was also an increase in average ED census and, based on increasing number of patients, the time to admission from ED triage decreased. The ED time to discharge and left without being seen did not significantly change.
Physician well-being and ED overcrowding are important issues with high financial, as well as emotional, costs. The introduction of flow facilitators to the ED seems to be an effective, targeted intervention to address physician well-being and improve radiology result times.
鉴于2020年代医生职业倦怠达到了创纪录的水平，迫切需要制定解决方案来应对这一趋势。
在本研究中，我们旨在评估流程促进者作为一种干预措施，以改善急诊科医生的幸福感。在急诊科设立了一个新职位，并评估其对医生幸福感的影响。
对一家大型学术医院的急诊医生进行匿名调查，并开会讨论影响幸福感和工作满意度的因素。基于这次会议和调查结果，医院系统聘请了三名全职员工担任“流程促进者”，其主要任务是简化急诊科的后勤挑战，目标是减少等待时间并提高医生满意度。然后对急诊医生进行调查，以评估实施急诊科流程促进者后他们自我报告的满意度变化。还评估了患者满意度和良好结果（未就诊离开率/等待时间）的客观指标，并确定现有流程促进者需要进一步改进的具体领域。
医生对该项目的反应绝大多数是积极的，最一致的积极反应是认为后勤挑战比临床挑战有了改善。超过85%的医生认为该项目改善了他们的整体幸福感。具体的吞吐量指标显示，对于计算机断层扫描、超声和X射线检查，从下单到获得结果的时间显著减少。急诊科平均普查人数也有所增加，并且基于患者数量的增加，从急诊科分诊到入院的时间减少。急诊科出院时间和未就诊离开时间没有显著变化。
医生的幸福感和急诊科拥挤是重要问题，会带来高昂的经济和情感成本。在急诊科引入流程促进者似乎是一种有效的、有针对性的干预措施，可解决医生的幸福感问题并改善放射学检查结果时间。
