From Headache to Handled: Advanced In-Basket Management System in Primary Care Clinics Reduces Provider Workload Burden and Self-Reported Burnout

Abstract

Background The electronic health record (EHR) has been associated with provider burnout, exacerbated by increasing In-Basket burden.

Objectives We sought to study the impact of implementing a team-based approach to In-Basket management on a series of primary care ambulatory sites.

Methods We performed a workflow analysis of the transition to the Advanced In-Basket Management (AIM) nurse team triage for six family medicine clinic locations in a large health system. We abstracted and analyzed associated provider workflow metrics from our EHR. We conducted a postintervention provider survey on satisfaction with the AIM project and provider burnout.

Results The AIM project was implemented in six family medicine clinics after provider townhalls and workgroup development. A nurse team curriculum was created using the principles of “maturing the message” before sending it to a provider and “only handle it once” to improve response efficiency. Provider workload metrics abstracted from the EHR demonstrated 12.2 fewer In-Basket messages per provider per day (p < 0.05), 6.3 fewer minutes per provider per day worked outside scheduled hours (p < 0.05), 3.5 fewer minutes spent in the In-Basket per provider per day (p < 0.05), but 13.7 more seconds spent per completed message per provider (p = 0.017), likely attributable to increased message complexity. Sixty-four percent of providers reported no burnout symptoms in a postintervention survey, 56% agreed that the AIM project reduced their burnout, and approximately 70% of providers agreed that the AIM project was acceptable and appropriate for their clinic.

Conclusion The AIM project demonstrates team-based nurse In-Basket triage is possible to implement across multiple primary care sites, is an acceptable intervention for providers, can reduce provider workload burden and self-reported provider burnout.

Keywords

family medicine - practice management - interdisciplinary workflows - electronic communication

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed and approved by the Baylor Scott and White Research Institute Institutional Review Board.

Publikationsverlauf

Eingereicht: 25. April 2024

Angenommen: 01. August 2024

Artikel online veröffentlicht:
23. Oktober 2024

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