Impact of a standardized quality care model on anxiety in patients retained in the emergency department: A retrospective study

Abstract

Anxiety is common in emergency department (ED) patients, affecting physiological stability, treatment adherence, and clinical outcomes. Standardized quality care models may alleviate these effects, but further validation is needed. This study evaluates the impact of a standardized quality care model on anxiety, physiological parameters, and quality of life in ED patients. This retrospective cohort study included 205 ED patients treated between January 2021 and December 2023, selected using consecutive sampling. Patients were categorized into the standardized quality care group (n = 95) or the routine care group (n = 110) based on prior nursing care. Anxiety and depression were assessed using SAS, HAMA, GAD-7, and self-depression scale (SDS), and psychological distress with SCL-90. Quality of life was measured using social functioning (SF)-36v2, while physiological indicators (heart rate, blood pressure, oxygen saturation), patient satisfaction, and medical compliance were recorded. Statistical analyses were conducted using SPSS 26.0, with independent sample t-tests or Mann–Whitney U tests for continuous variables and chi-square (χ²) tests for categorical variables (P < .05 considered significant). The standardized care group had significantly lower anxiety (SAS, HAMA, GAD-7) and depression (SDS) scores than the routine care group (P < .05). Moderate to severe psychological distress (SCL-90) was also lower (P = .015). Physiological indicators, including heart rate (P = .012), systolic blood pressure (P = .03), diastolic blood pressure (P = .03), and oxygen saturation (P = .03), improved significantly. At the 1-month follow-up, SF-36v2 scores, including physical component summary and mental component summary, were significantly higher in the standardized care group (P < .05). Patient satisfaction (χ² = 13.28, P = .004) and medical compliance (χ² = 6.01, P = .049) were also improved. The standardized quality care model effectively reduces anxiety and depression, enhances physiological stability, and improves quality of life, patient satisfaction, and treatment adherence in ED patients. These findings support integrating structured nursing interventions into ED care. Larger prospective studies are needed to validate long-term benefits and explore technology-driven enhancements.

1. Introduction

The emergency department (ED) plays a critical role in managing emergencies and critically ill patients, where operational efficiency and quality of care are directly linked to patient safety and recovery outcomes.^[1] With advancements in medical technology and an aging population, the volume and complexity of ED cases have increased, leading to greater workload pressures and clinical challenges.^[2] In this high-stress environment, patients frequently experience anxiety due to the urgency of their condition, treatment uncertainty, and extended waiting times.^[3] Studies indicate that anxiety levels in ED patients are influenced not only by their medical condition but also by environmental factors, communication barriers, and long wait times.^[4,5]

As a common psychological response, anxiety affects both mental and physical health, triggering physiological changes such as increased heart rate, elevated blood pressure, and immune suppression.^[6] These effects can prolong consultation times, reduce treatment efficacy, and increase the likelihood of medical disputes.^[7] Additionally, high anxiety levels negatively impact patient cooperation and treatment adherence, ultimately compromising clinical outcomes.^[8] A systematic review further highlights the direct correlation between anxiety levels, patient satisfaction, and adherence to treatment, particularly in pain management and condition assessment.^[9]

Routine care remains the primary approach in ED nursing, addressing basic medical needs but often failing to accommodate patients’ complex psychological demands.^[10] Staff shortages and heavy workloads further limit the ability of nurses to provide personalized psychological support, resulting in unmet emotional needs and persistent anxiety.^[11] Research indicates that the absence of standardized quality care for anxiety management in routine ED settings may prolong hospital stays and increase the risk of clinical deterioration.^[12]

In contrast, the quality nursing model has gained recognition for its systematic, standardized approach, enhancing care efficiency and patient outcomes through evidence-based interventions.^[13] This comprehensive model not only addresses physiological needs but also prioritizes psychological well-being, thereby enhancing the overall patient experience.^[14] Studies demonstrate that quality care interventions significantly reduce anxiety and depression, improve patient satisfaction and adherence, and contribute to better mental health (MH) outcomes.^[15,16] Specifically, implementing structured quality care in ED settings has been shown to lower anxiety scores, enhance psychological stability, and improve patients’ overall quality of life.^[17]

However, the high-pressure nature of the ED necessitates further validation of the standardized quality care model. ED patients present with diverse medical conditions, high psychological stress, and complex nursing needs, requiring more structured and rigorous care approaches.^[18] Developing and evaluating a tailored standardized quality care model for the ED is both theoretically and clinically significant, particularly in its potential to effectively reduce patient anxiety and improve overall care outcomes.^[19]

2. Methodology and analyses

2.1. Study design

This study was approved by the Ethics Committee of West China Hospital. As a retrospective clinical study, it did not involve patient intervention. To ensure privacy and confidentiality, all data were anonymized and de-identified and were used exclusively for academic purposes. The study complied with international ethical guidelines for retrospective research, as data were obtained from existing clinical records, contained no identifiable patient information, and posed no risk to patient rights. By retrospectively analyzing the data of patients who stayed in the ED from January 2021 to December 2023, a total of 205 eligible patients were selected using a consecutive sampling method. Patients who received standardized quality care (n = 95) were compared with those who received conventional care (n = 110) to assess differences in anxiety relief, physiological indices, and quality of life between the 2 care models. The overall process is shown in Figure 1.

Figure 1.

Flow chart.

2.2. Study subjects

Inclusion criteria: age ≥ 18 years, both genders; stayed in the ED for treatment between January 2021 and December 2023; received complete nursing records and psychological assessments during the stay; able to understand and complete psychological assessments.

Exclusion criteria: history of mental illness or cognitive impairment; serious verbal communication impairments preventing completion of anxiety assessments; inability to cooperate with standardized care due to acute critical conditions or other severe illnesses (e.g., major trauma, multi-organ failure); repeat admissions – only the first hospital stay was included.

2.3. Standardised quality care measures

The standardized quality care model includes the following:

1. Psychological support: dedicated staff trained in psychological care ensure that each patient undergoes at least 1 comprehensive psychological assessment during their stay. Based on the assessment, a personalized counseling plan is developed, incorporating at least 1 face-to-face emotional counseling session. cognitive behavioral therapy and other evidence-based interventions are utilized to alleviate anxiety symptoms and enhance emotional well-being.

2. Environmental improvement: The detention ward environment is optimized to ensure a quiet, clean, and comfortable setting. Noise and light disturbances are minimized to create an optimal environment for patient rest and recovery.

3. Patient communication: strengthening communication between nursing staff, patients, and families is prioritized. Nurses engage with each patient at least 3 times daily (morning, noon, and evening) to provide treatment explanations, expected outcomes, and nursing interventions. Regular meetings with families address concerns promptly, fostering patient security and trust. Patient feedback is systematically recorded after each interaction to ensure that nursing measures remain aligned with patient needs.

4. Health education: biweekly health lectures cover disease knowledge, rehabilitation guidance, and self-management skills. Nursing staff provide at least 30 minutes of daily self-care instruction, monitoring and recording patient progress. Educational pamphlets and videos on common emergency conditions, self-care, and psychological adjustment techniques are made available, ensuring continuous patient access to essential health information.

5. Multidisciplinary collaboration: a team of doctors, nurses, and psychologists collaboratively develops and implements comprehensive care plans. Regular multidisciplinary consultations ensure care coordination and integration. For patients with complex conditions or high care needs, daily multidisciplinary consultations facilitate timely adjustments and optimization of care strategies.

6. Quality control measures: to ensure the consistent implementation and effectiveness of the standardized quality care model, a nursing quality supervision team was established. This team was responsible for: conducting regular audits and random inspections to assess compliance with standardized protocols. Implementing monthly evaluations of nursing performance, including psychological support measures, patient communication effectiveness, and adherence to health education programs. Collecting patient feedback through satisfaction surveys, with results used for continuous improvement. Organizing weekly nursing quality meetings to review cases, address challenges, and optimize care strategies. Providing ongoing training sessions for nursing staff to ensure adherence to updated guidelines and best practices.

The routine care model includes basic medical care such as routine monitoring of vital signs, medication administration, and basic life care. However, it lacks systematic measures for psychological support, structured health education, personalized emotional counseling, multidisciplinary collaboration, and environmental optimization. Unlike the standardized quality care model, it does not incorporate targeted interventions for anxiety management, proactive patient communication, or comprehensive follow-up strategies.

2.4. Nursing staff training and compliance

All nursing staff participating in the standardized quality care model completed a 4-week specialized training program covering psychological support, environmental optimization, effective communication, health education, and multidisciplinary collaboration. A nursing quality supervision team was established to monitor compliance, conducting regular inspections, random interviews, and sampling to ensure adherence to standardized protocols. Monthly assessments incorporated patient feedback to identify and address gaps in care delivery. Additionally, continuous education and training opportunities were provided to update nursing knowledge and skills, ultimately enhancing care quality and patient satisfaction.

2.5. Data sources

This study utilized data from the hospital’s electronic medical records and nursing documentation, encompassing patient demographics, including age, gender, marital status, education level, and occupation, as well as clinical characteristics such as admission reasons, emergency screening index (ESI) classification, and history of mental illness. Information on nursing interventions related to the implementation of standardized quality care measures was also included. Patient assessments comprised anxiety (SAS, HAMA, GAD-7), depression (SDS), and psychological distress (SCL-90). Additionally, physiological indicators, including heart rate, blood pressure, and oxygen saturation, were documented. Quality of life and medical compliance were evaluated using the SF-36v2 scale, alongside measures of patient satisfaction and treatment adherence.

2.6. Study variables

The independent variable in this study was the type of care model received, categorized as either the standardized quality care model or the routine care model. Dependent variables included MH indicators, assessed using the self-rating anxiety scale (SAS), Hamilton anxiety scale (HAMA), generalized anxiety disorder scale (GAD-7), and self-rating depression scale (SDS), as well as psychological distress, measured by SCL-90 positive scores. Physiological indicators comprised heart rate (beats/min), blood pressure (systolic/diastolic, mm Hg), pulse pressure (mm Hg), and oxygen saturation (%). Quality of life was evaluated using the SF-36v2 brief health status questionnaire, covering physical functioning (PF), role function limitation (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), emotional role limitation (RE), and MH. Patient satisfaction was assessed through a self-administered questionnaire, with responses categorized as very satisfied, satisfied, fair, or dissatisfied. Medical compliance was evaluated based on patients’ cooperation with treatment, classified as full cooperation, cooperation, or noncooperation. Finally, symptomatic relief was measured by tracking changes in the patient’s condition during hospitalization, classified as complete relief, partial relief, no change, or exacerbation.

2.7. Methods of statistical analysis

The sample size was determined based on power analysis for multiple scales used in this study, including SAS, HAMA, GAD-7, SDS, SCL-90, and SF-36. For each scale, an independent power calculation was performed, considering an expected effect size of 0.5 (moderate effect), a significance level of α = 0.05, and a statistical power of 80% (β). The estimated sample sizes varied across scales, with the highest requirement being 88 patients per group. The sample size is calculated as follows:

$${\displaystyle \begin{array}{l}{\displaystyle n=\frac{2{\sigma }^2{(Z_{\alpha /2}+Z_{\beta })}^2}{{\delta }^2}}\end{array}}$$

Data were analyzed using SPSS statistical software (version 26.0, Chicago) following these steps:

Descriptive Statistics: Basic patient characteristics (e.g., age, gender, marital status) were summarized using mean ± standard deviation (Mean ± SD) for continuous variables or frequency (n) and percentage (%) for categorical variables.

2.8. Group comparisons

Continuous variables: independent samples t-tests were used to compare variables such as age, heart rate, and blood pressure between the standardized quality care group and the routine care group.

Categorical variables: Chi-square tests (χ²) were applied to analyze differences in variables like gender, marital status, and education between the 2 groups.

Non-normally distributed data: for nonparametric score data (e.g., SAS, HAMA, GAD-7), the Mann–Whitney U test was employed.

Significance level: a P-value < .05 was considered statistically significant.

3. Results

3.1. Patient information

The study included 205 ED patients, with 95 in the standardized quality care group (mean age: 35.19 ± 13.81 years) and 110 in the routine care group (mean age: 36.86 ± 12.81 years). Regarding gender distribution, the standardized care group comprised 45 males (47.4%) and 50 females (52.6%), while the routine care group included 53 males (48.2%) and 57 females (51.8%).

There were no statistically significant differences (P > .05) between the 2 groups in terms of demographic and clinical characteristics, including marital status, education level, occupation, reason for admission, illness severity (based on ESI classification), history of mental illness, consultation time, waiting time, presence of family accompaniment, smoking, and alcohol consumption, as detailed in Table 1.

Table 1.

Basic information (x ± s, n/%).

		Standardised quality care (N = 95)	routine care (N = 110)	t/χ2/Z	P-value
Age		35.19 ± 13.81	36.86 ± 12.81	t = 0.893	.37
Sex	Male	45 (47.4%)	53 (48.2%)	χ2 = 0.019	.89
	Female	50 (52.6%)	57 (51.8%)
Marriage status	Married	84 (88.4%)	97 (88.2%)	χ2 = 0.003	.95
	Unmarried	11 (11.6%)	13 (11.8%)
Educational level	Primary and below	8 (8.4%)	9 (8.2%)	χ2 = 0.677	.71
	Secondary/Specialised	65 (68.4%)	70 (63.6%)
	University and above	22 (23.2%)	31 (28.2%)
Occupation	Farmers	9 (9.5%)	12 (10.9%)	χ2 = 9.25	.14
	Workers	16 (16.8%)	17 (15.5%)
	Enterprise Employee	14 (14.7%)	21 (19.1%)
	Civil Servant or Institution Employee	13 (13.7%)	17 (15.5%)
	Students	9 (9.5%)	15 (13.5%)
	Retirees	12 (12.6%)	11 (10.0%)
	Others	22 (23.2%)	17 (15.5%)
Reason for admission	chest pain	19 (20.0%)	24 (21.8%)	χ2 = 2.53	.77
	Abdominal pain	21 (22.1%)	29 (26.4%)
	Dyspnoea	12 (12.6%)	9 (8.2%)
	trauma	17 (17.9%)	24 (21.8%)
	Fainting	10 (10.5%)	11 (10.0%)
	Other	16 (16.8%)	13 (11.8%)
Severity of illness ESI classification	1	4 (4.2%)	5 (4.5%)	χ2 = 1.24	.85
	2	8 (8.4%)	12 (10.9%)
	3	33 (34.7%)	41 (37.3%)
	4	35 (36.8%)	33 (30.0%)
	5	15 (15.8%)	19 (17.3%)
History of mental illness	Yes	4 (4.2%)	5 (4.5%)	χ2 = 0.0135	.91
	No	91 (95.8%)	105 (95.5%)
Consultation times	8 to 20 pm	56 (58.9%)	67 (60.9%)	χ2 = 0.081	.78
	20 to 8 pm the next day	39 (41.1%)	43 (39.1%)
Waiting time for admission		21.34 ± 9.23	22.15 ± 10.03	t = 0.602	.55
Accompanied by family	Yes	83 (87.4%)	97 (88.2%)	χ2 = 0.028	.867
	No	12 (12.6%)	13 (11.8%)
Smoking	Yes	35 (36.8%)	43 (39.1%)	χ2 = 0.119	.73
	No	60 (63.2%)	67 (60.9%)
Drink (alcohol)	Yes	37 (38.9%)	47 (42.7%)	χ2 = 0.315	.575
	No	58 (61.1%)	63 (57.3%)

ESI = emergency screening index.

3.2. Anxiety scores

On the self-assessment scale for anxiety (SAS), 11.6% of patients in the standardized quality care group were classified as normal, significantly higher than the 5.5% in the routine care group (χ² = 10.757, P = .012). The proportion of patients with mild anxiety was also higher (28.4% vs 13.6%), whereas the proportions of those with moderate (35.8% vs 46.4%) and severe anxiety (24.2% vs 34.5%) were significantly lower than in the routine care group.

Similarly, the Hamilton anxiety scale (HAMA) revealed lower overall anxiety scores in the standardized care group (mean = 10.42, P = .03). The proportion of patients with no anxiety symptoms (10.5% vs 6.4%) and probable anxiety (23.2% vs 9.1%) was significantly higher, while the proportion with present, marked, or severe anxiety was significantly lower than in the routine care group.

The generalized anxiety disorder scale (GAD-7) further confirmed the superior anxiety outcomes in the standardized quality care group (mean = 10.6, P = .015), with a significantly higher proportion of normal and mild anxiety cases and a lower proportion of moderate and severe anxiety cases compared to the routine care group. These findings are detailed in Table 2.

Table 2.

Grade distribution of patients’ anxiety scores (n/%).

		Standardised quality care (N = 95)	routine care (N = 110)	χ2	P-value
SAS	<50 (normal)	11 (11.6%)	6 (5.5%)	10.757	.012
	50 to 59 (mild anxiety)	27 (28.4%)	15 (13.6%)
	60 to 69 (moderate anxiety)	34 (35.8%)	51 (46.4%)
	>70 (severe anxiety)	23 (24.2%)	38 (34.5%)
HAMA	<7 (no symptoms of anxiety)	10 (10.5%)	7 (6.4%)	10.42	.03
	7 to 13 (possible anxiety)	22 (23.2%)	10 (9.1%)
	14 to 20 (anxiety present)	22 (23.2%)	30 (27.3%)
	21 to 28 (significant anxiety)	26 (27.4%)	36 (32.7%)
	>28 (severe anxiety)	15 (15.8%)	27 (24.5%)
GAD-7	0 to 4 (normal range)	8 (8.4%)	3 (2.7%)	10.6	.015
	5 to 9 (mild anxiety)	23 (24.2%)	12 (10.9%)
	10 to 14 (moderate anxiety)	37 (38.9%)	54 (49.1%)
	15 to 21 (severe anxiety)	27 (28.4%)	41 (37.3%)

GAD-7 = generalized anxiety disorder-7, HAMA = Hamilton anxiety scale, SAS = self-rating anxiety scale.

3.3. Depression scores

The self-depression scale (SDS) results indicated that 15% of patients in the standardized quality care group had normal-range depression scores, significantly higher than the 9% in the routine care group (χ² = 10.76, P = .013). The proportion of patients with mild depression was also higher in the standardized care group (38% vs 28%), while the proportions of moderate (29% vs 47%) and severe depression (13% vs 26%) were significantly lower than in the routine care group.

Regarding psychological distress, assessed by SCL-90, the standardized care group had a significantly higher proportion of patients with normal-range scores (17% vs 8%) and mild psychological distress (25% vs 18%). Conversely, the proportions of moderate (35% vs 53%) and severe psychological distress (18% vs 31%) were notably lower in the standardized care group (χ² = 10.55, P = .015). These findings highlight the positive impact of standardized quality care on reducing depression and psychological distress. Detailed results are presented in Table 3.

Table 3.

Grade distribution of patients’ depression scores (n/%).

		Standardised quality care (N = 95)	routine care (N = 110)	χ2	P-value
SDS	<53 points (normal)	15 (15.8%)	9 (8.2%)	10.76	.013
	53 to 62 points (mild depression)	38 (40.0%)	28 (25.5%)
	63 to 72 points (moderate depression)	29 (30.5%)	47 (42.7%)
	>72 (severe depression)	13 (13.7%)	26 (23.6%)
Mean score of positive SCL-90 items on the symptom self-assessment scale	1.0 to 1.5 (normal range)	17 (17.9%)	8 (7.3%)	10.55	.015
	1.5 to 2.0 (mild psychological distress)	25 (26.3%)	18 (16.4%)
	2.0 to 2.5 (moderate psychological distress)	35 (36.8%)	53 (48.2%)
	> 2.5 (severe psychological distress)	18 (18.9%)	31 (28.2%)

SDS = self-rating depression scale.

3.4. Physiological indicators

As shown in Table 4, the standardized quality care group demonstrated significantly better physiological indicators compared to the routine care group (P < .05). The mean heart rate in the standardized care group was 87.03 ± 11.02 beats/min, significantly lower than 91.13 ± 12.12 beats/min in the routine care group (t = 2.535, P = .012). Additionally, systolic blood pressure (122.89 ± 25.82 mm Hg vs 130.83 ± 26.35 mm Hg, t = 2.176, P = .03), diastolic blood pressure (84.03 ± 12.63 mm Hg vs 88.03 ± 13.89 mm Hg, t = 2.16, P = .03), and pulse pressure (39.24 ± 9.57 mm Hg vs 42.43 ± 10.25 mm Hg, t = 2.305, P = .022) were all significantly lower in the standardized care group. Furthermore, oxygen saturation was significantly higher in the standardized care group (94.83 ± 5.17% vs 93.63 ± 6.37%, t = 2.17, P = .03), indicating better oxygenation levels in patients receiving standardized care.

Table 4.

Physiological indicators of patients (x ± s).

		Standardised quality care (N = 95)	Routine care (N = 110)	t	P-value
Heart rate		87.03 ± 11.02	91.13 ± 12.12	2.535	.012
Blood pressure	Systolic blood pressure	122.89 ± 25.82	130.83 ± 26.35	2.176	.03
	Diastolic blood pressure	84.03 ± 12.63	88.03 ± 13.89	2.16	.03
	Pulse Pressure	39.24 ± 9.57	42.43 ± 10.25	2.305	.022
Oxygen saturation		94.83 ± 5.17	93.63 ± 6.37	2.17	.03

3.5. Symptom relief

In terms of symptom relief, the standardized quality care group demonstrated significantly better outcomes. The proportion of patients achieving complete remission was 23.2% (n = 22) in the standardized care group, significantly higher than 10% (n = 11) in the routine care group. Conversely, the proportion of patients experiencing symptom exacerbation was 11.6% (n = 11) in the standardized care group, notably lower than 19.1% (n = 21) in the routine care group (χ² = 8.972, P = .03). However, the proportions of patients with partial remission and no change did not differ significantly between the 2 groups, as detailed in Table 5.

Table 5.

Patients’ symptom relief (n/%).

		Standardised quality care (N = 95)	Routine care (N = 110)	χ2	P-value
Symptom relief	Full remission	22 (23.2%)	11 (10.0%)	8.972	.03
	Partial remission	38 (40.0%)	40 (36.4%)
	No change	24 (25.3%)	38 (34.5%)
	Exacerbation	11 (11.6%)	21 (19.1%)

3.6. Nursing care satisfaction and medical compliance

As shown in Table 6, patient satisfaction was significantly higher in the standardized quality care group compared to the routine care group (χ² = 13.28, P = .004). The proportion of patients who were very satisfied was 27.4% (n = 26) in the standardized care group, notably higher than 13.6% (n = 15) in the routine care group. Similarly, satisfied patients accounted for 45.3% (n = 43) in the standardized care group, compared to 35.5% (n = 39) in the routine care group.

Table 6.

Patient satisfaction and medical compliance (n/%).

		Standardised quality care (N = 95)	routine care (N = 110)	χ2	P-value
Satisfaction	Very satisfied	26 (27.4%)	15 (13,6%)	13.28	.004
	Satisfactory	43 (45.3%)	39 (35.5%)
	Average	19 (20.0%)	38 (34,5%)
	Unsatisfactory	7 (7.4%)	18 (16.4%)
Medical accessibility	Full cooperation	32 (33.7%)	22 (20.0%)	6.01	.049
	Cooperate	58 (61.1%)	76 (69.1%)
	Not cooperating	5 (5.3%)	12 (10.9%)

Regarding medical compliance, the proportion of patients who fully cooperated was significantly higher in the standardized care group (33.7%, n = 32) than in the routine care group (20%, n = 22). Additionally, the proportion of noncooperative patients was lower in the standardized care group (5.3%, n = 5) than in the routine care group (10.9%, n = 12), indicating better adherence to medical instructions (χ² = 6.01, P = .049).

3.7. Quality of life

For the patients’ quality of life measures before and after treatment, we used the SF-36v2 scale, as detailed in Table 7. On the day of the visit, there were no statistically significant differences between the standardized quality care group and the routine care group in most health dimensions (P > .05). However, the standardized care group showed significantly better scores in BP (t = 2.016, P = .045), vitality (VT) (t = 2.18, P = .03), and MH (t = 2.0, P = .046). Additionally, although the physical composite summary (PCS) (t = 0.870, P = .101) and mental composite summary (MCS) (t = 1.51, P = .097) scores were slightly higher in the standardized quality care group, the differences did not reach statistical significance. These results suggest that at the time of consultation, standardized quality care had a measurable positive effect on pain perception, vitality, and MH, but its impact on overall physical and MH summary scores was not yet evident.

Table 7.

Patients’ health status scores (x ± s).

SF-36 brief health status questionnaire		Standardised quality care (N = 95)	Routine care (N = 110)	t	P-value
Day of consultation
	PF	54.53 ± 6.82	55.53 ± 6.23	1.096	.274
	RP	43.28 ± 6.02	42.88 ± 5.34	0.504	.615
	BP	53.21 ± 6.79	51.21 ± 7.31	2.016	.045
	GH	47.03 ± 7.06	45.19 ± 8.18	1.71	.089
	PCS	49.5125	48.7025	0.870	.101
	VT	56.47 ± 5.98	54.47 ± 7.01	2.18	.03
	SF	42.99 ± 7.45	42.06 ± 6.06	0.985	.325
	Emotional RE	37.22 ± 5.57	35.77 ± 6.91	1.638	.103
	MH	46.72 ± 4.99	45.23 ± 5.59	2	.046
	MCS	45.85 ± 4.95	44.38 ± 5.06	1.51	.097
After 1 mo
	PF	65.23 ± 5.43	62.54 ± 6.22	3.27	.001
	RP	57.28 ± 6.64	54.28 ± 7.28	3.065	.002
	BP	75.21 ± 5.99	72.65 ± 5.83	3.094	.002
	GH	72.53 ± 7.23	69.73 ± 5.33	3.178	.002
	PCS	67.56 ± 5.01	64.8 ± 5.16	3.210	.002
	VT	77.43 ± 5.22	74.84 ± 6.14	3.22	.001
	SF	73.23 ± 6.26	69.54 ± 6.81	4.02	<.0001
	Emotional RE	57.22 ± 6.92	54.09 ± 5.39	3.636	.0003
	MH	58.72 ± 6.29	56.66 ± 6.47	2.3	.022
	MCS	66.65 ± 5.03	63.78 ± 5.31	3.55	.001

BP = body pain, GH = general health, MCS = mental composite summary, MH = mental health, PCS = physical composite summary, PF = physical function, RE = role limitation, RP = restricted role function, SF = social functioning.

In the follow-up survey after 1 month, significant differences were observed in all 8 health dimensions of the SF-36v2, with the standardized quality care group consistently scoring higher than the routine care group (P < .05). The improvements were particularly notable in PF (t = 3.27, P = .001), restricted role functioning (RP) (t = 3.065, P = .002), BP (t = 3.094, P = .002), GH (t = 3.178, P = .002), vitality (VT) (t = 3.22, P = .001), SF (t = 4.02, P < .0001), emotional role limitation (RE) (t = 3.636, P = .0003), and MH (t = 2.3, P = .022). Importantly, PCS (t = 3.210, P = .002) and MCS (t = 3.55, P = .001) scores were also significantly higher in the standardized care group, indicating an overall enhancement in both physical and MH status over time. The above data indicate that standardized quality care is superior to conventional care measures for patients, both in terms of short-term and long-term effects.

4. Discussion

This study provides compelling evidence that a standardized quality care model is more effective than conventional care in reducing anxiety and depression, improving physiological indicators, and enhancing the overall quality of life in ED patients. By addressing both physiological and psychological aspects through structured interventions, this model significantly improves patient outcomes, as demonstrated by lower anxiety (SAS, HAMA, GAD-7), depression (SDS), and psychological distress (SCL-90) scores in the standardized care group compared to the routine care group. These findings contribute to the growing body of research supporting integrated, patient-centered emergency care and align with previous studies emphasizing the role of multidisciplinary, structured interventions in ED settings.^[3,7,14,20]

5. Psychological impact and anxiety reduction

A key finding of this study is the substantial reduction in anxiety and depression among patients receiving standardized quality care. Compared to conventional care, this model led to lower SAS, HAMA, and GAD-7 scores, confirming that structured psychological support, enhanced communication, and environmental improvements play a pivotal role in reducing anxiety symptoms. These results are consistent with Borekci et al, who demonstrated that incorporating psychological counseling and multidisciplinary support significantly alleviated distress in ED patients.^[7] Similarly, Çağlar et al reported that tailored patient-centered care and systematic psychological interventions improved anxiety outcomes and overall well-being.^[3]

The mechanism underlying this improvement likely involves sympathetic nervous system regulation. High anxiety levels in emergency settings are often associated with increased sympathetic activation, leading to elevated heart rate and blood pressure.^[6] Our study found that patients in the standardized care group exhibited significantly lower heart rate, systolic and diastolic blood pressure, and higher oxygen saturation levels compared to those in the routine care group. This suggests that psychological interventions not only reduce subjective distress but also produce measurable physiological benefits, supporting findings from previous research emphasizing the mind-body connection in critical care settings.^[5,9]

6. Quality of life and functional recovery

Patients in the standardized quality care group also reported higher SF-36v2 scores across all health dimensions, reflecting improvements in both physical (PCS) and mental (MCS) health-related quality of life. This aligns with Smith and Wallace, who found that comprehensive, personalized care models improved both functional status and emotional well-being in emergency patients.^[20] The role of environmental optimization in this improvement should not be overlooked. Studies suggest that a calming and well-structured hospital environment significantly reduces patient distress and enhances recovery.^[5] Our findings reinforce this, as patients in the standardized care group – who received care in an environment with reduced noise, improved lighting, and structured patient communication – demonstrated better psychological and physiological recovery compared to those receiving conventional care.

Furthermore, our study highlights the link between improved quality of life and enhanced treatment adherence. Patients who received standardized care exhibited higher medical compliance and satisfaction rates, which are critical factors influencing long-term treatment success. These findings align with Osterwalder et al, who reported that structured nursing interventions significantly improved patient adherence and reduced hospital readmissions in emergency settings.^[14]

7. Clinical implications

The findings of this study have important clinical implications. First, they provide strong empirical support for implementing standardized quality care models in emergency nursing. Given that anxiety negatively impacts treatment adherence, physiological stability, and overall prognosis, integrating psychological support, structured communication, and environmental improvements should be a priority in ED nursing protocols. Secondly, the higher satisfaction and compliance rates observed in our study suggest that hospitals adopting this model may experience fewer medical disputes, improved patient trust, and enhanced healthcare efficiency, ultimately contributing to better patient-centered emergency care.

Additionally, our study underscores the importance of multidisciplinary collaboration. Given that emergency care requires rapid decision-making and holistic patient management, an integrated team approach involving nurses, physicians, and psychologists ensures that both medical and psychological needs are addressed simultaneously. McVeigh et al reported similar findings, emphasizing that multidisciplinary, patient-centered care models significantly enhance treatment outcomes by improving communication, care coordination, and patient engagement.^[21]

8. Limitations and future directions

Despite these promising results, our study has several limitations. First, the study was conducted in a single hospital, which may limit its generalizability. Future studies should include larger, multi-center cohorts to validate these findings across diverse healthcare settings. Second, the follow-up period was limited to 1 month, making it difficult to assess long-term benefits of standardized quality care. Extending the follow-up period in future research would provide a clearer picture of its sustained impact on anxiety, adherence, and recovery rates.

Furthermore, while our study demonstrated the overall effectiveness of the standardized care model, it did not quantify the independent contributions of each intervention component (e.g., psychological support, environmental modifications, multidisciplinary collaboration). Future research should incorporate subgroup analyses to determine which components have the most significant impact on patient outcomes.

Finally, technological advancements could further enhance the standardized quality care model. Integrating mobile health applications, real-time psychological monitoring, and AI-driven patient support tools could personalize care interventions and optimize patient management, leading to even greater improvements in anxiety reduction and patient satisfaction. Future studies should explore how information technology can be leveraged to further refine and enhance this care model.

9. Conclusion

This study provides strong evidence that a standardized quality care model effectively reduces anxiety and depression, improves physiological stability, enhances quality of life, and increases patient adherence and satisfaction in ED patients. These findings reinforce the importance of integrated, structured care models that address both physical and psychological needs. Future research should focus on long-term outcomes, multi-center validation, and the role of digital health innovations in optimizing emergency nursing care.

Author contributions

Conceptualization: Fang Chen, Jingyuan Jiang, Lei Ye.

Data curation: Fang Chen, Jingyuan Jiang, Lei Ye.

Formal analysis: Fang Chen, Jingyuan Jiang, Xiaoli Chen, Dongmei Diao, Xing Xia, Lei Ye.

Investigation: Fang Chen, Xiaoli Chen, Dongmei Diao, Xing Xia, Lei Ye.

Methodology: Fang Chen, Xiaoli Chen, Xing Xia, Lei Ye.

Validation: Lei Ye.

Visualization: Lei Ye.

Writing – original draft: Fang Chen, Jingyuan Jiang, Xiaoli Chen, Dongmei Diao, Lei Ye.

Writing – review & editing: Fang Chen, Lei Ye.