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The impact of support provided by close others in the emergency department on threat perceptions.

ABSTRACT: Objective: Having close others present in the emergency department (ED) can cause patients significant distress. The present study tested the hypothesis that close others provide more negative support than non-close others as a potential explanation for this effect.Design: Participants were 493 patients evaluated for an acute coronary syndrome (ACS) in the ED (M_Age = 62.01, SD_Age = 13.55; 49.49% male) and who arrived with close others (i.e. spouse/partner, child) or non-close others (e.g. neighbour). Patients self-reported support from companions and threat perceptions (in-ED and at recall approximately three days later).Main outcome measures: Positive support (comfort, responsiveness); negative support (made patients anxious, required comforting); threat perceptions (feeling helpless, vulnerable).Results: Close (vs non-close) others provided patients with marginally more positive support, but also required more comfort, B = 0.32, p = .050, and caused patients more anxiety, B = 0.24, p = .009. Anxiety was associated with patients' Threat Perceptions: in-ED, B = 0.11, p = .002; recall, B = 0.14, p < .001; as was provision of comfort to support partners: recall, B = .06, p = .005.Conclusion: Negative support may be one mechanism underlying the association between close others and patient distress in the ED.

SUBMITTER: Cornelius T

PROVIDER: S-EPMC6980514 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Bringing close others to the emergency department for an acute coronary event is associated with increased patient perception of threat.

Project description:ObjectiveRelationship quality is one of the most consistent psychosocial predictors of physical and mental health. Yet, little research examines relationship types or support within the immediate context of acute health events. We tested the unexplored role that close others play in patients' experience of threat during evaluation for acute coronary syndrome (ACS) in the Emergency Department (ED), as well as the indirect effect of close others on ACS-induced posttraumatic stress disorder (PTSD).MethodParticipants were 871 patients evaluated for ACS at an urban academic ED (60.86 years old; 54.08% male; 56.37% Hispanic, 19.86% Black, 16.65% White). Threat perceptions were assessed in-ED and median 3 days later. ACS-induced PTSD was assessed median 41 days later using the PTSD checklist cued to a specific stressor. Non-overlapping categories were created representing close others in the ED (i.e., spouse/significant other, child), non-close others (e.g., neighbor), or no one.ResultsPatients who brought close others recalled experiencing greater threat in the ED: vs. no one, b = 0.11, p = .072; vs. non-close others, b = 0.16, p = .030. There was no direct effect of close others on ACS-induced PTSD; however, recalled threat mediated the effect of close others on development of ACS-induced PTSD, ps < .05.ConclusionsClose others were associated with recalling greater threat during ED evaluation, which predicted ACS-induced PTSD. ACS-induced PTSD is associated with medication nonadherence, event recurrence, and mortality, highlighting the need to develop a greater understanding of the impact stressful medical environments have on patients and close others.

| S-EPMC6353683 | biostudies-literature

Development and Validation of a Measure to Assess Patients' Threat Perceptions in the Emergency Department.

Project description:OBJECTIVE:Threat perceptions in the emergency department (ED; e.g., patients' subjective feelings of helplessness or lack of control) during evaluation for an acute coronary syndrome (ACS) are associated with the development of posttraumatic stress disorder (PTSD), and PTSD has been associated with medication nonadherence, cardiac event recurrence, and mortality. This study reports the development and validation of a seven-item measure of ED threat perceptions in English- and Spanish-speaking patients evaluated for ACS. METHODS:Participants were drawn from an observational cohort study of 1,000 patients evaluated for ACS between 2013 and 2016 in a large New York City hospital. Participants reported on threat perceptions in the ED and during inpatient stay (using 12 items previously identified as predictive of PTSD) and reported on cardiac-induced PTSD 1 month postdischarge. Exploratory and confirmatory factor analyses were used to establish the factor structure and test measurement invariance. Validity and reliability were examined, as was the association of ED threat perceptions with cardiac-induced PTSD. RESULTS:Factor analyses identified a seven-item measure of ED threat perceptions (e.g., "I feel helpless," "I am worried that I am going to die") for both English- and Spanish-speaking patients. ED threat perceptions demonstrated convergent validity, correlating with ED stress and ED crowdedness (r = 0.29 and r = 0.14), good internal consistency (? = 0.82), and stability (r = 0.61). Threat perceptions were associated with cardiac-induced acute stress at inpatient and PTSD symptoms at 1 month (r = 0.43 and r = 0.39). CONCLUSIONS:This brief tool assessing ED threat perceptions has clinical utility for providers to identify patients at risk for developing cardiac-induced PTSD and is critical to inform research on whether threat may be modified in-ED to reduce PTSD incidence.

| S-EPMC6185758 | biostudies-literature

Perceptions of nurse practitioners by emergency department doctors in Australia.

Project description:BACKGROUND: The Australian Medical Association is strongly opposed to the nurse practitioner (NP) role with concerns that NPs may become doctor substitutes without the requisite training and education that the medical role demands. Despite this, NPs have been heralded by some as a potential solution to the access block, workforce shortage and increased demand affecting emergency departments (EDs). AIMS: The purpose of this study was to determine the perception of NPs by medical staff working in Australian EDs. METHODS: Semi-structured telephone interviews were conducted with closed and open-ended questions. Participants were drawn from a representative stratified sample of two city, two metropolitan and two provincial hospitals of each State/Territory. RESULTS: A total of 95 doctors from 35 EDs participated in this study including 36 Departmental Directors; 36% of participating Directors indicated having an NP on staff. Doctors were strongly opposed to the statement that NPs could replace either nurses or other prevocational doctors; 71 interviewees commented on the role of NPs in the ED. Thematic analyses revealed polarised views held by doctors. Eight major themes were identified, the most common being that there is a lack of clarity of the NP role definition, their scope of practice and differentiation from the medical role. CONCLUSION: Although ED NPs represent a highly skilled professional group their role is poorly understood by ED doctors. Opposition to the NP role is a significant barrier to the introduction of great numbers of ED NPs as a strategy to overcome the medical workforce shortage. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s12245-010-0214-8) contains supplementary material, which is available to authorized users.

| S-EPMC3047829 | biostudies-other

Doctors' perceptions of the impact of upfront point-of-care testing in the emergency department.

Project description:OBJECTIVES:Special investigations (e.g. blood tests, electrocardiograms, x-rays) play an integral role in patient management in the emergency department (ED). Having results immediately available prior to assessing a patient may lead to improved efficiency. This could be instituted by utilizing point-of-care (POC) testing with an alternative ED workflow, but the implementation would be dependent on acceptance by the end-users. The aim of this study was to assess doctors' perceptions of POC testing in the ED when the normal treatment pathway was modified to use upfront POC tests performed prior to doctor evaluation in an effort to decrease treatment times. METHODS:A prospective, randomized, controlled trial was performed in the ED where medical patients received either the normal ED workflow pathway or one of the enhanced workflow pathways with POC tests in various combinations prior to doctor evaluation. At the end of the study period, doctors were invited to participate in an anonymous survey to gauge their opinions on the implementation of the early POC testing. RESULTS:Overall, the doctors surveyed were very satisfied with use of upfront POC in the ED. One hundred per cent of the 28 doctors surveyed found it helpful to assess patients who already had test results available and would want it to be permanently available. Normalized satisfaction scores were more favorable for combinations of 3 or more tests (0.7-1.0) as opposed to combinations with 2 or less tests (0.3-0.7). There was a preference for combinations that included comprehensive blood results. CONCLUSION:The implementation of workflow changes to assist doctors in the ED can potentially make them more productive. End-user buy-in is essential in order for the change to be successful. Upfront, protocolised, POC testing is a low-input, high-yield intervention that decreased treatment time and satisfied doctors.

| S-EPMC6292565 | biostudies-literature

Emergency Department-Provided Home Blood Pressure Devices Can Help Detect Undiagnosed Hypertension.

Project description:IntroductionEmergency departments (EDs) are critical sites for hypertension (HTN) screening. Home blood pressure (BP) monitoring (HBPM) is used routinely in outpatient settings, yet its utility after the ED visit for those with elevated BP in the ED is unclear.AimIn this pilot study, we assessed if HBPM could detect HTN in patients with elevated in-ED BP.MethodsFrom September 2014 to July 2017, we recruited adult patients at an urban, academic ED with a triage BP ≥ 120/80 mmHg and no history of HTN into this prospective cohort observational study. After their ED visit, participants obtained BP measurements for two weeks using a validated HBPM. HTN was considered probable if the average HBPM BP was ≥ 135/85 mmHg. We calculated the proportion of participants whose ED BP measurement accurately predicted HTN using HBPM after discharge.ResultsOf 136 participants enrolled, 93 (68%) returned the HBPM with at least four home BP measurements [mean number of measurements obtained: 29 (SD: 17, range 4-59)]. Participants' median age was 40 years-old (IQR 34-48); 55% were female, 19% were black, and 58% were white. Forty-six percent of participants with elevated in-ED BP had HTN in follow-up.ConclusionsFor patients with elevated BP in the ED, HBPM could be valuable for determining which patients have HTN and require expedient follow-up.

| S-EPMC6407636 | biostudies-literature

Correction: Doctors' perceptions of the impact of upfront point-of-care testing in the emergency department.

Project description:[This corrects the article DOI: 10.1371/journal.pone.0208655.].

| S-EPMC6350991 | biostudies-literature

The presence of companions during emergency department evaluation and its impact on perceptions of clinician-patient communication.

Project description:OBJECTIVES:Research in outpatient setting suggests that the presence of companions during a medical encounter can improve clinician-patient communication. It is not known if the presence of companions has a similar effect in the acutely stressful context of the ED. This study tested whether the presence of companions in the ED relate to stronger clinician-patient communication. We further explored effect modification by demographic factors (race/ethnicity, education and language) thought to compromise communication. METHODS:Participants were drawn from an observational cohort study of patients with suspected acute coronary syndrome (n=876) recruited from an urban academic medical centre between 2013 and 2016. Patient interviews occurred both in the ED and post-ED discharge; communication was assessed using the Interpersonal Processes of Care Survey with possible range of scores of 14-70. Companions were categorised as close others (ie, partner/spouse or child), non-close others (eg, neighbour) or no one. RESULTS:Perceptions of clinician-patient communication were high (mean=57.1, SD=10.6;). There was no association between companions (close/non-close/no one) and clinician-patient communication, p=0.262. Demographic factors were unrelated to communication. There was a significant interaction between education and companions. Having a close other in the ED was associated with stronger clinician-patient communication only for patients with high school education or less, p=0.027. CONCLUSIONS:Neither the presence of companions nor demographic factors were related to clinician-patient communication. The interaction effect suggesting that patients completing high school or less have the most to gain from the presence of close others warrants further exploration.

| S-EPMC6335085 | biostudies-literature

The current status and effects of emergency drug shortages in China: Perceptions of emergency department physicians.

Project description:OBJECTIVES:The shortage of emergency drugs in China is severe. This study aimed to characterize emergency drug shortages in China and to measure their effects. METHODS:An online questionnaire based on a literature review was sent to emergency department physicians in Chinese secondary and tertiary hospitals from November 2016 to February 2017. The survey asked physicians questions about their experiences with emergency drug shortages. RESULTS:In total, 236 physicians from 29 provinces participated in the survey. According to their responses, 90.7% of the respondents experienced drug shortages during the last year. More than half of the physicians (65.7%) reported that drug shortages occurred at least once a month. Hospitals in the eastern and western regions of China had more emergency drugs in shortage than hospitals in central China, especially those with many inpatient beds (?800). In addition, the shortage situation was more serious in secondary hospitals than in tertiary hospitals. More respondents agreed that original medicines, injections, essential medicines, medicines without alternative agents and cheap medicines were more susceptible to shortages than generics, oral medicines, nonessential medicines, medicines with alternative agents and expensive medicines, respectively. Most respondents thought that drug shortages always, often or sometimes affected patients [delayed therapy (62.6%), longer rescue and recovery times (58.9%) and higher costs (58.7%)] and physicians [inconvenience (81.0%), higher pressure (76.5%) and harm to patient-doctor relationships (72%)] and compromised hospital reputations (55.1%). CONCLUSIONS:The shortage of emergency drugs in China is serious, especially in secondary hospitals located in eastern and western China. Emergency drug shortages have significant effects on patients and physicians.

| S-EPMC6177176 | biostudies-other

Gene Expression Profiles in Children with Suspected Sepsis in the Emergency Department

Project description:Around 42,000 children suffer from severe sepsis each year in the US alone, resulting in significant morbidity, mortality and billion dollar expenditures in the US healthcare system. Sepsis recognition is a clinical challenge in children. Biomarkers are needed to tailor appropriate antimicrobial therapies and improve risk stratification. The goal of this study was to determine if gene expression profiles from peripheral blood were associated with pathogen type and sepsis severity in children treated for suspected sepsis.

2020-01-01 | GSE119217 | GEO

Impact of emergency physician-provided patient education about alternative care venues.

Project description:OBJECTIVES:Interventions that focus on educating patients appear to be the most effective in directing healthcare utilization to more appropriate venues. We sought to evaluate the effects of mailed information and a brief scripted educational phone call from an emergency physician (EP) on subsequent emergency department (ED) utilization by low-risk adults with a recent treat-and-release ED visit. STUDY DESIGN:Patients were randomized into 3 groups for post-ED follow-up: EP phone call with mailed information, mailed information only, and no educational intervention. Each intervention group was compared with a set of matched controls. METHODS:We undertook this study in 6 EDs within an integrated healthcare delivery system. Overall, 9093 patients were identified; the final groups were the phone group (n = 609), mail group (n = 771), and matched control groups for each (n = 1827 and n = 1542, respectively). Analysis was stratified by age (<65 and ?65 years). Patients were educated about available venues of care delivery for their future medical needs. The primary outcome was the rate of 6-month ED utilization after the intervention compared with the 6-month utilization rate preceding the intervention. RESULTS:Compared with matched controls, subsequent ED utilization decreased by 22% for patients 65 years or older in the phone group (P = .04) and by 27% for patients younger than 65 years in the mail group (P = .03). CONCLUSIONS:ED utilization subsequent to a low-acuity ED visit decreased after a brief post-ED education intervention by an EP explaining alternative venues of care for future medical needs. Response to the method of communication (phone vs mail) varied significantly by patient age.

| S-EPMC6180915 | biostudies-literature

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