Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Correlation between crowdedness in emergency departments and anxiety in Chinese patients
Shuang Wang, Jun-Yi Gao, Xiang Li, Yu Wu, Xiao-Xia Huo, Chao-Xia Han, Meng-Jie Kang, Hong Sun, Bao-Lan Ge, Yu Liu, Ying-Qing Liu, Jian-Ping Zhou, Zhen Wang
Shuang Wang, Xiao-Xia Huo, Chao-Xia Han, Zhen Wang, Department of Emergency Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Jun-Yi Gao, Department of Cardiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Xiang Li, Meng-Jie Kang, Emergency Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Yu Wu, Department of Orthopedic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Hong Sun, Department of Emergency Medicine, Peking University People’s Hospital, Beijing 100044, China
Bao-Lan Ge, Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
Yu Liu, Department of Emergency Medicine, Chinese PLA General Hospital, Beijing 100853, China
Ying-Qing Liu, Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
Jian-Ping Zhou, Department of Emergency Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
Author contributions: Wang S participated in the study design, oversaw the study, was involved in data collection and analysis, performed the statistical analysis, and drafted the manuscript; Gao JY participated in the design of the study and commented on the draft manuscript; Li X was involved in data collection and analysis and assisted in drafting the manuscript; Wu Y was involved in data collection and analysis and assisted in drafting the manuscript; Huo XX was involved in data collection and analysis; Han CX, Kang MJ, Sun H, Ge BL, Liu Y, Liu YQ, and Zhou JP were involved in data collection and analysis and contributed to the statistical analysis; Wang Z participated in design and oversight of the study and commented on the draft manuscript; all authors read and approved the final version of the submitted manuscript.
Supported by the Capital Nursing Research Special Project, No. 17HL21.
Institutional review board statement: This study was reviewed and approved by the institutional review board of Beijing Shijitan Hospital, Capital Medical University (Beijing, China) (No. SJT 2018-12).
Clinical trial registration statement: This study is not a clinical trial study.
Informed consent statement: All study participants, or their legal guardian, provided written informed consent prior to enrollment in the study.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhen Wang, MD, PhD, Director, Professor, Department of Emergency, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Road, Yangfangdian, Haidian District, Beijing 100038, China. wangzhen1369@aliyun.com
Received: January 17, 2020
Peer-review started: January 17, 2020
First decision: May 1, 2020
Revised: May 13, 2020
Accepted: June 2, 2020
Article in press: June 2, 2020
Published online: July 6, 2020
BACKGROUND
Emergency department (ED) overcrowding is a severe health care concern, while anxiety and depression rates among ED patients have been reported to be substantially higher compared to the general population. We hypothesized that anxiety due to over crowdedness may lead to adverse events in EDs.
AIM
To investigate correlations between crowdedness in EDs and anxiety of patients and nurses, and to identify factors affecting their anxiety.
METHODS
In this prospective observational study, a total 43 nurses and 389 emergency patients from two tier III hospitals located in Beijing were included from January 2016 to August 2017. Patients were grouped into inpatients when they were hospitalized after diagnoses, or into outpatients when they were discharged after treatments. The State Trait Anxiety Inventory (STAI Form Y) questionnaire was used to investigate patient and nurse anxieties, while crowdedness of EDs was evaluated with the National Emergency Department Over Crowding Score.
RESULTS
The present results revealed that state anxiety scores (49.50 ± 6.00 vs 50.80 ± 2.80, P = 0.005) and trait anxiety scores (45.40 ± 5.70 vs 46.80 ± 2.70, P = 0.002) between inpatients (n = 173) and outpatients (n = 216) were significantly different, while the state anxiety of nurses (44.70 ± 5.80) was different from those of both patient groups. Generalized linear regression analysis demonstrated that multiple factors, including crowdedness in the ED, were associated with state and trait anxieties for both inpatients and outpatients. In addition, there was an interaction between state anxiety and trait anxieties. However, multivariable regression analysis showed that while overcrowding in the ED did not directly correlate with patients’ and nurses’ anxiety levels, the factors that did correlate with state and trait anxieties of inpatients were related to crowdedness. These factors included waiting time in the ED, the number of patients treated, and the number of nurses in the ED, whereas for nurses, only state and trait anxieties correlated significantly with each other.
CONCLUSION
Waiting time, the number of patients treated, and the number of nurses present in the ED correlate with patient anxiety in EDs, but crowdedness has no effect on nurse or patient anxiety.
Core tip: Emergency department (ED) overcrowding is a severe concern and an important manifestation of dysfunction in the medical system, resulting in a decline in the quality of emergency medical services. In the present study, ED overcrowding did not directly correlate with patient or nurse anxiety levels, but anxiety of inpatients correlated with the waiting time, the number of patients treated, and the number of nurses in the ED. Reducing unnecessary ED visits and optimizing the procedures for emergency patients’ diagnoses and treatments are likely to reduce the anxiety of patients in EDs.
