Crowded emergency department has psychologic impact

By Eleanor McDermid, Senior medwireNews Reporter

The likelihood for patients with acute coronary syndromes (ACS) developing post-traumatic stress disorder (PTSD) rises with emergency department (ED) crowding, research suggests.

Although the findings come from a fairly small study involving just one ED, the researchers say their results indicate "the need for greater awareness of the influence of medical environments on patients' psychological well-being, while underscoring the need for hospital administrators and policymakers to address ED overcrowding."

Donald Edmondson (Columbia University Medical Center, New York, USA) and co-workers gauged ED crowding according to the total number of admissions in the 12 hours before and after the admission time of each ACS patient in the analysis. As reported in JAMA Internal Medicine, they found that increasing crowding correlated with patients' PTSD symptoms on the Impact of Events Scale-Revised (IES-R) at 1 month after ED admission.

The researchers suggest that "a more chaotic environment may foster or inflate perceptions of increased life threat and decreased control, which may in turn contribute to greater acute psychological and physiological arousal." They add that ED crowding may also impair physician-patient communication.

The patients' average IES-R score was about 2 points for patients in the lowest tertile of ED crowding, rising to about 4 points in the middle tertile and 8 points in the top tertile. The association remained significant after accounting for confounders including age, gender, education, previous myocardial infarction, comorbidities, and depressive symptoms at the time of hospitalization.

In an editorial note, Patrick O'Malley suggests that strategies to avoid psychologic ill effects on patients could "include innovative designs of emergency departments and ward rooms, and triage processing of critical patients to environments that minimize exposure to the disruptive mayhem of other hospital activities."

He says: "Of course, physicians should always be mindful of the patient's experience and work to optimize his or her comfort, both physical and emotional. But if we can build structures and develop processes that make it easier to care for patients in optimal environments, then we will be better able to care for patients."

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