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.
- clinical care
- emergency department
Data availability statement
Data are available on reasonable request.
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Handling editor Loren De Freitas
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.
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