RESUMEN
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.
RESUMEN
OBJECTIVE: To analyze the etiology, therapy and influential factors in fever patients during the epidemic of severe acute respiratory syndrome (SARS), so as to define early and differential diagnosis for SARS from other disease with fever. METHODS: The epidemiological and the clinical data of 4060 patients with fever admitted to the emergency department of the Third Hospital affiliated to Peking University from March 5th to May 10th in 2003 were analyzed, and their influential factors were evaluated. RESULTS: Of 4060 patients with fever 275 cases were admitted to the isolated ward, 145 cases were diagnosed as SARS (3.75 percent), 29 belonged to suspected cases, and in 101 cases SARS was ruled out. Ninety-three cases were non-SARS-pneumonia, 2 were epidemic encephalitis, 8 were epidemic cerebrospinal meningitis, and 3 cases were epidemic hemorrhagic fever. CONCLUSION: During epidemic of SARS, the etiology of fever is influenza or other virus infection in 90 percent of patients. Non-SARS-pneumonia and infectious diseases with fever accounted for certain proportion of patients with fever. Our diagnostic level should be improved. SARS could not be ruled out only by a high white blood cells count. Chest X-ray examination have to be repeated, because abnormal chest X-ray do not always appear at the same time with fever.