Key result
Higher ED crowding is linked to lower perceived interpersonal care among suspected ACS patients.
Why the study?
It was unknown whether ED crowding is associated with perceptions of interpersonal care in patients evaluated for ACS.
Is emergency department crowding associated with poorer perceptions of interpersonal care in patients evaluated for suspected acute coronary syndrome?
Observational (n=933)
No
Is emergency department crowding associated with poorer perceptions of interpersonal care in patients evaluated for suspected acute coronary syndrome?
Increased emergency department crowding at admission is associated with poorer patient perceptions of interpersonal care among those evaluated for suspected ACS.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating for ED crowding effects on interpersonal care in suspected ACS; prospective studies needed before practice implications.
BACKGROUND: . We examined whether ED crowding was associated with perceptions of interpersonal care in patients evaluated for acute coronary syndrome (ACS). METHODS: Patients presenting to a quaternary academic medical centre ED in New York City for evaluation of suspected ACS were enrolled between November 2013 and December 2016. ED crowding was measured using the ED Work Index (EDWIN), which incorporates patient volume, triage category, physician staffing and bed availability. Patients completed the 18-item Interpersonal Processes of Care (IPC) survey, which assesses communication, patient-centred decision-making and interpersonal style. Regression analyses examined associations between EDWIN and IPC scores, adjusting for demographics, comorbidities and depression. RESULTS: Among 933 included patients, 11% experienced ED overcrowding (EDWIN score >2) at admission, 11% experienced ED overcrowding throughout the ED stay and 30% reported suboptimal interpersonal care (defined as per-item IPC score <5). Higher admission EDWIN score was associated with modestly lower IPC score in both unadjusted (β=-1.70, 95% CI -3.15 to -0.24, p=0.02) and adjusted models (β = -1.77, 95% CI -3.31 to -0.24, p=0.02). EDWIN score averaged over the entire ED stay was not significantly associated with IPC score (unadjusted β=-1.30, 95% CI -3.19 to 0.59, p=0.18; adjusted β=-1.24, 95% CI -3.21 to 0.74, p=0.22). CONCLUSION: Increased crowding at the time of ED admission was associated with poorer perceptions of interpersonal care among patients with suspected ACS.
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Liyanage-Don et al. (2021) conducted an observational in suspected acute coronary syndrome (n=933). Emergency department crowding (EDWIN score) was evaluated on Interpersonal Processes of Care (IPC) score (adjusted β -1.77, 95% CI -3.31 to -0.24, p=0.02). Higher emergency department crowding at admission was associated with lower perceptions of interpersonal care among patients with suspected ACS.
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