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Associations between emergency department crowding and perceptions of interpersonal care in patients presenting with suspected acute coronary syndrome
  1. Nadia A Liyanage-Don1,2,
  2. David S Edelman3,4,
  3. Bernard P Chang5,
  4. Katharina Schultebraucks5,
  5. Anusorn Thanataveerat1,
  6. Ian M Kronish1,2
  1. 1Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York, USA
  2. 2Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
  3. 3Columbia University Mailman School of Public Health, New York, New York, USA
  4. 4Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
  5. 5Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
  1. Correspondence to Dr Ian M Kronish, Center for Behavioral Cardiovascular Health, Division of General Medicine, Columbia University Irving Medical Center, New York, New York, USA; ik2293{at}cumc.columbia.edu

Abstract

Background Emergency department (ED) crowding is associated with numerous healthcare issues, but little is known about its effect on psychosocial aspects of patient-provider interactions or interpersonal care. 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.

  • crowding
  • interpersonal
  • clinical care
  • emergency department
  • quality

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • Handling editor Loren De Freitas

  • Twitter @d_edelman9

  • Presented at This work was accepted as an abstract at the 2020 Society of General Internal Medicine Annual Meeting (held virtually in May 2020 due to COVID-19).

  • Contributors IMK and BPC conceived and designed the study; supervised the study protocol, participant recruitment and data collection and obtained research funding. NAL-D and IMK conceived and designed the substudy. AT and KS provided statistical advice on study design. NAL-D and DSE analysed the data. NAL-D drafted the manuscript, and all authors contributed substantially to its revision. IMK takes responsibility for the paper as a whole.

  • Funding This work was supported by grants R01-HL123368, R01-HL117832, R01-HL128310, R01-HL141811 and R01-HL146911 from the National Institutes of Health/National Heart, Lung, and Blood Institute.

  • Disclaimer The study sponsor had no role in the study design; collection, analysis or interpretation of data; manuscript preparation or decision to submit the manuscript for publication.

  • Competing interests NAL-D reports no conflicts of interest. DSE reports no conflicts of interest. KS reports no conflicts of interest. AT reports no conflicts of interest. BPC’s institution received grant funding (R01-HL141811, R01-HL146911) from the National Institutes of Health/National Heart, Lung, and Blood Institute to conduct investigator-initiated research at Columbia University Irving Medical Center. IMK’s institution received grant funding (R01-HL123368, R01-HL117832, R01-HL128310) from the National Institutes of Health/National Heart, Lung, and Blood Institute to conduct investigator-initiated research at Columbia University Irving Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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