Crowded EDs can cause stress disorder, more heart attacks

Emergency department crowding may cause post -traumatic stress disorder (PTSD) in heart attack patients, which can lead to more heart attacks or mortality, according to a new study in the Journal of the American Medical Association.

The study, noting most heart attack patients first head to the ED, indicates the initial medical environment can influence patients' experiences.

"What we're showing here is--aside from the severity of a heart attack--the emergency department environment itself can carry forward and impact a person's psychological adjustment after," lead study author Donald Edmondson of Columbia University Medical Center told Reuters.

When entering an overcrowded and chaotic ED, patients may pick up on the stress of the doctors and nurses, Reuters noted.

The meta-analysis found that 12 percent of patients with acute coronary syndrome develop PTSD symptoms, which are associated with a doubled risk of another heart attack or dying within three years.

In addition to stress disorders, high ED crowding also is associated with increased inpatient mortality and moderate rises in length of stay and costs, according to a study last December in the Annals of Emergency Medicine.

To keep medical environments from contributing to distress and morbidity, hospitals should consider ways to redesign emergency departments, ward rooms and triage processing, according to an accompanying editor's note.

ED leaders also must make better use of the space they have to prevent overcrowding, healthcare leaders told FierceHealthcare for a special report last month. One way to make the most of ED capacity is to use internal waiting rooms, said Jesse Pines, a FierceHealthcare Editorial Advisory Board member and director of the Center for Healthcare Quality at George Washington University.

To learn more:
- here's the JAMA study and editor's note
- read the Reuters article