Abstract
BackgroundPatient demographic characteristics have been associated with longer emergency department (ED) treatment times, but the influence of psychosocial characteristics has not been assessed. We evaluated whether depression was associated with greater ED length of stay (LOS) in non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA) patients presenting to a large metropolitan academic medical center.MethodsWe calculated ED LOS for NSTEMI or UA patients enrolled an observational cohort study by taking the difference between ED triage time in the medical record and time of transfer to an inpatient bed from standardized transfer documentation forms. Depression status was defined as current, past, or never by clinical interview and also by self-report on the Beck Depression Inventory.ResultsParticipants were 120 NSTEMI/UA patients [mean age= 62, 36% women, 56% Hispanic, 26% Black/African American, 40% NSTEMI, mean global registry of acute cardiac events (GRACE) score= 93.9]. Mean ED LOS was 11.6 hours, SD= 8.3. A multiple linear regression model that included the above demographic and clinical variables, and time of presentation to ED, explained 11% of the variance in ED LOS, F (11, 108)= 2.35, p= .01, R2 adj.= .11. Currently depressed patients spent 5.4 more hours (95% CI= .40, 10.4 hours) in the ED on average than patients who had never been depressed.ConclusionsCurrently depressed NSTEMI/UA patients are in the ED for an average of 5 hours longer than those who have never been depressed. Further research is needed to identify the reasons for this difference.
Highlights
Patient demographic characteristics have been associated with longer emergency department (ED) treatment times, but the influence of psychosocial characteristics has not been assessed
Though few studies assess individual-level length of stay (LOS), evidence from the National Hospital Ambulatory and Medical Care Survey suggests that patient demographic characteristics may be associated with longer individual ED LOS, and one large study found that the presence of a language barrier between physician and patient was associated with significantly longer individual ED LOS [10]
Patients were eligible to participate if they were diagnosed with acute coronary syndrome, as defined by unstable angina, non-ST elevation myocardial infarction (NSTEMI), or ST-elevation myocardial infarction (STEMI), and diagnosis was confirmed by 2 independent cardiologists
Summary
Patient demographic characteristics have been associated with longer emergency department (ED) treatment times, but the influence of psychosocial characteristics has not been assessed. We evaluated whether depression was associated with greater ED length of stay (LOS) in non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA) patients presenting to a large metropolitan academic medical center. The emergency department (ED) is the first point of contact with the medical system for the majority of patients treated for ACS, Emergency department length of stay (LOS) is a key marker of ED performance, and longer ED LOS may be associated with adverse clinical outcomes for some conditions [5], in particular those with ACS. The effect of psychological factors on ED LOS has not been described
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