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Patients’ lives put at risk while waiting for emergency care

Death rates were eight percent higher among patients who had been forced to wait for between six and eight hours before being admitted to hospital.


Emergency Medical Team Wheeling the Patient Along the Hospital Corridor

By Tom Campbell via SWNS

Patients' lives are being put at risk while waiting hours for emergency care, warns a new study.

Those waiting more than five hours before being admitted to hospital could miss out on vital treatment - and be exposed to infections, say scientists.

To tackle overcrowding, a four-hour wait time target before being admitted, transferred or discharged from hospital was first introduced in England in 2004 and later across the UK.

Several other countries such as Australia and Canada have followed suit, but with rising patient demand, performance against this target has steadily declined in recent years.

Now, researchers at the Royal Bolton Hospital have found these delays could cost patients their lives. Their findings were published in the BMJ, Emergency Medicine Journal.

Author Dr. Chris Moulton said: “The results from this study show that there is a 'dose-dependent' association between time in excess of five hours in the emergency department for admitted patients and their all-cause 30-day mortality.

"Moreover, 30-day mortality is a relatively crude metric that does not account for either increases in patient morbidity or for the inevitably worse patient experiences."

The researchers reviewed every patient admitted to hospital from each major (type 1) emergency department in England between April 2016 and March 2018.

Death records from any cause within 30 days of admission were compared with those otherwise to be expected, allowing for a wide range of influential factors.

These included the patient's sex, age and level of deprivation, while also taking into account health conditions, the time of day and month, previous emergency admissions and crowding in the emergency department at the time.

Between April 2016 and March 2018, some 26,738,514 people attended an emergency department in England, of which 5,249,891 were admitted to hospital.

The average wait in the emergency department was just under five hours, while the four-hour target was breached in 38 percent of cases, the researchers found.

Death rates were eight percent higher among patients who had been forced to wait for between six and eight hours before being admitted to hospital.

Emergency Room Entrance
(ESB Professional/ Shutterstock)

They were also 10 percent higher for those who waited even longer - between eight and 12 hours.

This translates as one extra death for every 82 patients who are delayed for six to eight hours, the researchers say.

Dr. Moulton said: "This study confirms that healthcare policymakers should continue to mandate timely admission from the emergency department in order to protect patients from hospital-associated harm.

“Despite limited supporting evidence, there are a number of clinically plausible reasons to accept that there is a temporal association between delayed admission to a hospital inpatient bed and poorer patient outcomes.”

Long stays in the emergency department have been linked to overcrowding which can delay access to vital treatment and cause extra long stays.

These increase the patient's risk of developing an infection at the hospital and suffering from physical or psychological strain.

Derek Prentice, of the Royal College of Emergency Medicine, said: "Let nobody be in doubt any longer, the NHS four-hour operational target is, as many of us have always known, of key importance to patient safety.”

While hospitals should meet their four-hour target, provided they have enough funding for NHS beds, staff and social care provision, these have been in short supply.

Mr. Prentice said: "Could there be better measures? Possibly, but until there are, and crucially, ones that have the support and trust of patients, the four-hour target or one very close to this, must remain the gold standard.

"Those in doubt need look no further than the evidence provided by this excellent paper."

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