Associations between emergency department crowding and perceptions of interpersonal care in patients presenting with suspected acute coronary syndrome.
Associations between emergency department crowding and perceptions of interpersonal care in patients presenting with suspected acute coronary syndrome.
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DOI：
10.1136/emermed-2020-210493
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发表时间：
2022-03
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急诊科 (ED) 拥挤与许多医疗保健问题相关，但人们对其对医患互动或人际护理的心理社会方面的影响知之甚少。我们检查了急诊室拥挤是否与接受急性冠脉综合征（ACS）评估的患者的人际护理认知相关。 2013 年 11 月至 2016 年 12 月期间，入组了前往纽约市四级学术医疗中心急诊科评估疑似 ACS 的患者。急诊科拥挤情况是使用急诊科工作指数 (EDWIN) 来衡量的，其中包括患者数量、分诊类别、医生人员配置和床位可用性。患者完成了包含 18 项的人际护理流程 (IPC) 调查，该调查评估沟通、以患者为中心的决策和人际风格。回归分析检查了 EDWIN 和 IPC 评分之间的关联，并根据人口统计、合并症和抑郁症进行了调整。在 933 名患者中，11% 的患者在入院时经历过 ED 过度拥挤（EDWIN 评分 >2），11% 的患者在整个 ED 住院期间经历过 ED 过度拥挤，30% 的患者报告人际护理欠佳（定义为每个项目 IPC 评分 <5）。在未调整模型（β=-1.70，95% CI -3.15 至 -0.24，p=0.02）和调整模型（β = -1.77，95% CI -3.31 至 -0.24，p=0.02）中，较高的入院 EDWIN 评分与较低的 IPC 评分相关。整个 ED 住院期间的平均 EDWIN 评分与 IPC 评分没有显着相关性（未调整 β=-1.30，95% CI -3.19 至 0.59，p=0.18；调整后 β=-1.24，95% CI -3.21 至 0.74，p=0.22）。疑似 ACS 患者入院时的拥挤程度与人际护理认知较差有关。
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). 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. 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). 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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