MedWire News: Heart attack patients and those with other forms of chest pain are significantly more likely to experience serious complications after admission to hospital if they were initially treated in a crowded emergency department, US research shows.

“What shocked us is that these complications were not explained by what goes on in the emergency department,” said lead researcher Dr Jesse Pines, from the University of Pennsylvania in Philadelphia. “The adverse events occurred after the patient had been admitted to the hospital. Emergency department crowding is really more of a marker of a dysfunctional hospital.”

Dr Pines and team studied data on 4574 patients who were admitted to hospital for symptoms of chest pain over an 8-year period. Of these, 802 were diagnosed with an acute coronary syndrome (chest pain of cardiac origin), 273 of whom had a true heart attack.

The patients suffered a total of 251 complications after they had been admitted to hospital following initial treatment in the emergency department. These complications included heart failure, delayed heart attacks, dangerously low blood pressure, heart rhythm problems (arrhythmias) and cardiac arrest.

The researchers found that patients with acute coronary syndrome were up to five times more likely to experience complications after hospital admission if they had been initially treated when the emergency department was at its highest occupancy level.

Patients without acute coronary syndrome, but who were still ill enough to be admitted to the hospital, were up to four times more likely to experience complications if they were initially treated in a crowded emergency department.

Although the reasons for their findings are unclear, the researchers suggest poorer care coordination, delays in testing and overburdened doctors and nurses in crowded emergency departments may be partly responsible for the increased risk of complications in hospitalised chest pain patients.

Commenting on the findings, co-researcher Dr Judd Hollander, also from the University of Pennsylvania, said: “While it’s difficult to know what complications are truly preventable, what we do know is that crowding is preventable. But hospitals have to allocate enough resources to their emergency departments so that errors are caught early and patients don’t suffer.”

Dr Pines added: “Once hospitals realise that their reputations will be tied to how long people wait, hospitals will have a greater incentive to reduce crowding and waiting. Making sure the emergency department isn’t crowded will certainly make patients happier, but our hope is this will make hospitals safer for everyone.”

The research will be published in a forthcoming issue of the journal Academic Emergency Medicine.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Journal