From Headache to Handled: Advanced In-Basket Management System in Primary Care Clinics Reduces Provider Workload Burden and Self-Reported Burnout
Open accessAbstract
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.
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Flagged first, then by citations
- Authors
- Smith, L., Kirk, W., Bennett, M. M., Youens, K., & Ramm, J.
- Affiliations
- Baylor Scott & White Health (US)
- Baylor Scott & White Medical Center - Temple (US)
- Corresponding author
- Ramm, Jason
- Venue
- Applied Clinical Informatics
- Publisher
- Georg Thieme Verlag KG
- Published
- 2024-10
- Volume
- 15
- Issue
- 05
- Pages
- 869-876
- ISSN
- 1869-0327 (ISSN-L)
- PMC
- PMC11498967
- OpenAlex
- W4403666990
- Cited by
- 7
- References
- 21
- Citations by year
- 2025: 7
- FWCI
- 2.14
- Type
- journal article
- Language
- en
- Open access
- green
- pmc.ncbi.nlm.nih.gov
- Locations
- Applied Clinical Informatics (publishedVersion)
- PubMed Central (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Keywords
- provider burnout, provider workload, nurse triage, team-based care, electronic health records, family medicine clinics, workflow analysis, message complexity, primary care
- MeSH terms
- Ambulatory Care Facilities, Burnout, Professional, Headache, Health Personnel, Humans, Primary Health Care, Workload, Workflow, Electronic Health Records, Self Report
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