Can Overcrowded and Chaotic Emergency Departments Predispose Some Patients to Post- Traumatic Stress?

For many patients, the emergency department (ED) is the initial point of contact with the medical environment. A recent study suggests that an overcrowded and chaotic atmosphere in the ED may contribute to an increased risk of post-traumatic stress disorder (PTSD).

The study, published in the Journal of the American Medical Association, correlates overcrowding, long wait times, and the high-stress atmosphere in the ED with an increase in PTSD symptoms in acute coronary syndrome (ACS) patients. PTSD in these patients has been associated with a doubled risk of ACS recurrence or mortality within one to three years. PTSD also contributes to poor quality of life and increased medical care requirements.

This study is believed to be the first to address the possibility that the environment in the healthcare setting may contribute to a traumatic impact on patients with ACS.  Researchers hypothesize that the ED atmosphere may exacerbate the patient’s perception of loss of control and insecurity, which can increase acute psychological and physiological arousal.

In conducting the study, researchers recorded the time of presentation for 135 patients at the ED of a large New York City teaching hospital. The average length of stay in the ED was more than 11 hours. The average age of the patients studied was 63. Increased measures of ED crowding were associated with higher ACS-induced PTSD symptoms at one month.

Overcrowding as a Healthcare Issue

The Institute of Medicine (IOM) recently identified ED overcrowding as a public health problem caused, in part, by treatment delays and resulting in lower patient satisfaction. ED crowding may also contribute to poor cardiovascular outcomes in patients who present with chest pain. Although the study was based on a small sample, it suggests that healthcare providers need to increase awareness of how the medical environment can influence the patient’s psychological well-being and, in particular, address the problem of overcrowded EDs. In an editorial that accompanied the study’s report, Patrick O’Malley, MD, MPH, of Walter Reed Army Medical Center noted the “extremely frightening” effect that the ED environment can have on patients and advised healthcare professionals to build structures and develop processes that make it easier to care for patients in optimal environments. “At the very least,” Dr. O’Malley warned, “our environments of care should not be contributing to morbidity.

To learn more about best nursing practices in psychiatric emergencies, look into Mosby’s ENA: Handling Psychiatric Emergencies online course.

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