P0505 - Emergency Department shift experiences: An exploratory sequential mixed methods study

Background: Emergency Department (ED) providers must juggle various physical, social, cognitive, behavioral, and affective demands. Past research has examined distal outcomes (e.g., burnout in the past year and over medical training), but little is known about proximal outcomes (e.g., mood at the moment) and associated ED-specific factors throughout ED shifts.

Objective: To investigate which ED-specific factors impact ED providers’ mood during shifts, and whether these impacts are more pronounced at the beginning, middle or end of shifts.

Methods: This was an exploratory sequential mixed methods study. First, the Nominal Group Technique was used to generate the ED Experience Survey (EDES), encompassing ED-specific factors that may influence provider mood during shifts. Second, the Experience Sampling Method was used to collect within-shift data: providers were alerted to complete the EDES and Positive And Negative Affect Schedule (PANAS; validated measure of mood) during the beginning, middle, and end of their shifts at randomly-generated times. Analyses were conducted using multilevel modeling of moods within shifts within persons.

Results: The EDES and PANAS were completed 221 times during 137 shifts by 52 ED providers, including 14 attendings, 9 house residents, 9 rotating residents, 7 fellows, 7 general pediatricians, and 6 nurse practitioners. Several factors were found to be significantly associated with changes in positive and negative moods during shifts (Table 1). Positive mood tended to increase with higher self-rated capacity to deal with challenging patient situations (p<0.001). Having to repeat patient assessments was negatively associated with positive mood during the beginning of shifts, but not during the rest of the time on duty (p=0.01). Changes in positive mood also varied across different groups of ED providers (p<0.001). ED attendings, fellows, urgent care pediatricians, and nurse practitioners tended to experience gradual declines in positive mood, particularly between the middle and end of their shifts, while residents showed a similar trajectory and rotating residents showed an opposite trajectory (Figure 2). Negative mood tended to decrease with higher self-rated quality of interactions with patients and families (p<0.001). Needing a restroom break during any time on duty was associated with negative mood (p<0.001). Furthermore, negative mood was associated with the need to process emotions during the beginning of shifts (p=0.01). Lastly, not knowing about patients’ outcomes was associated with negative mood during the end of shifts (p<0.001).

Conclusion: ED providers’ mood during shifts are impacted by ED-specific factors that span physical, social, behavioral, cognitive, and affective dimensions. Future research may further illuminate the experiences of working in the ED to support provider well-being as well as patient care.