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Long Waits in the ER May Raise PTSD Risk for Heart Patients

By Steven Reinberg
HealthDay Reporter

MONDAY, Feb. 11 (HealthDay News) -- People waiting for countless hours in crowded emergency rooms to be treated for a heart attack or severe chest pain may be at risk for developing post-traumatic stress disorder (PTSD), a new study suggests.

Typically, PTSD is associated with major traumatic experiences such as war or disasters, but it can also occur in highly stressful situations such as sitting in an emergency room for more than 11 hours, the Columbia University researchers said.

"The modern emergency department is excellent at acute care, but a number of health system and hospital-level pressures have overcrowded them to a point where being treated there can, at times, worsen long-term prognosis," said study author Donald Edmondson, an assistant professor of behavioral medicine.

Although it was small, this is the first study to document the psychological effects of overcrowding in the emergency room environment, he added.

"Most experts forecast that emergency department crowding will increase as health reform is implemented, because a lot of U.S. emergency departments have closed recently, and many newly insured patients will enter the system without access to good primary care, ending up in the emergency department," Edmondson explained.

For the more than 1 million Americans who have a heart attack or chest pain this year, "those overcrowded emergency departments will increase the stress of an already traumatic event, and may lead to increased PTSD symptoms and poor prognosis," he added.

The report was published in the Feb. 11 online edition of JAMA Internal Medicine.

To see what effects waiting in crowded emergency rooms might have, Edmondson's team noted the time when 135 heart patients arrived at a New York City emergency room between 2009 and 2011. The patients were part of a larger study.

Those who stayed in the emergency room for more than 11 hours were more likely to suffer symptoms of heart disease-related PTSD in the month following their stay, the researchers found.

PTSD symptoms are a risk factor for the recurrence of heart problems and death, the researchers noted. PTSD also contributes to poor quality of life, lower patient satisfaction and more use of the health care system, they added.

Symptoms of PTSD can include intrusive memories, avoidance, emotional detachment, increased anxiety, irritability and depression, according to the U.S. National Center for PTSD.

Simple organizational changes, such as better planning of surgeon schedules and protocols to handle overcrowding, have been shown to dramatically reduce emergency room crowding and improve patient outcomes, Edmondson said.

"Further, acute care and cardiac units dedicated to patients with possible heart problems not only reduce emergency room crowding, but also improve cardiac outcomes, are cost-effective and can shield patients from many frightening emergency room experiences," he said.

Dr. Donald Yealy, chair of emergency medicine at the University of Pittsburgh, agreed that the emergency room experience can be stressful to the point where one might develop PTSD symptoms.

"The limitation is [the] small size of the study and I don't know how big the impact is," he said. "But we need to look at this as one of the complications of emergency room crowding."

The solution to overcrowding needs to involve the entire hospital, he said. The emergency room is only the entry point for patients, meaning the hospital has to create systems for moving patients from the emergency room into specialized care as quickly as possible, he explained.

"Crowding is a function of the entire hospital system. It's not only an emergency department issue," Yealy said. "When the entire institution doesn't respond to the demands of the emergency department, it affects the health of each patient, particularly the sicker ones."

More information

Here's information on nurse burnout in the ER, from the Journal of Nursing.

SOURCES: Donald Edmondson, Ph.D., assistant professor, behavioral medicine, Columbia University Medical Center, New York City; Donald Yealy, M.D., professor and chair, emergency medicine, University of Pittsburgh; Feb. 11, 2013, JAMA Internal Medicine, online

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