Exploring the Impact of the Emergency Department Built Environment on Physician Workplace Stress: A Qualitative Study Utilizing High-Fidelity Virtual Reality.

Objectives: Physician burnout in emergency medicine has serious consequences. An underrecognized stressor for physicians may be the emergency department (ED) environment itself. EDs can be noisy and chaotic, lack natural light, and have challenging layouts that create patient care and safety concerns. This study examines the relationship between the ED-built environment and physician workplace stress. Methods: A qualitative study of ED-attending physicians from a level I trauma center ED in Philadelphia was conducted. Participants underwent a semistructured interview followed by a walkthrough of a high-fidelity virtual reality (VR) simulation of the participant's ED. In the VR simulation, they rated the overall comfort of 3 primary ED physician workspaces and provided commentary relating built environment elements to workplace stress. Thematic analysis identified key environmental stressors and a model was created. Results: Nineteen participants were enrolled. Identified themes from the interviews and VR simulations were grouped into a model by domain. The model demonstrated 3 domains of environmental stress: physical stress, emotional stress, and productivity stress. Emotional stress was associated with built environment elements contributing to moral injury, lack of privacy, or lack of security. Physical stress was associated with built environment elements contributing to physical exertion or an uncomfortable sensory experience. Productivity stress was associated with built environment elements that created barriers to providing care efficiently or distractions. Conclusion: This study establishes a relationship between the ED-built environment and physician workplace stress, identifying 3 primary stress domains. It also introduces VR simulation as a novel research tool for evaluating environmental stressors. Future research should explore how these stressors contribute to burnout and whether ED design modifications can mitigate stress.