Older patients spending night in ED before admission may have higher risk of in-hospital mortality and morbidity

For older patients who find themselves in the Emergency Department (ED) awaiting hospital admission, spending the night there may come at a significant cost. A recent study conducted across 97 EDs in France has brought to light the increased risk of in-hospital mortality for older adults who have to spend a night in the ED while waiting for a bed in a hospital ward.

The study was published in JAMA Internal Medicine by Melanie Roussel and colleagues. This prospective cohort study, conducted in December 2022, focused on patients aged 75 and above. They were admitted to the hospital after visiting the ED. The study compared two groups: those who stayed in the ED from midnight until 8:00 am (the ED group) and those who were admitted to a ward before midnight (the ward group).

The findings are alarming. The group of patients who spent the night in the ED faced a significantly higher in-hospital mortality rate, with 15.7% compared to 11.1% in the ward group. When adjusted for risk, the patients in the ED group had a 39% increased risk of in-hospital mortality.

Additionally, those who stayed overnight in the ED had a higher risk of experiencing adverse events, including falls, infections, bleeding, myocardial infarction, stroke, thrombosis, bedsores, and dysnatremia. Their risk of adverse events was 24% higher when compared with the ward group.

The study also examined the impact on the length of hospital stay. Patients who spent the night in the ED had a median length of stay of 9 days, whereas those in the ward group had a median stay of 8 days. This represents a 20% increase in the length of hospitalization.

In a subgroup analysis, the study focused on patients who required assistance with activities of daily living, revealing even more alarming findings. For this subgroup, spending the night in the ED was associated with an 81% increased risk of in-hospital mortality.

The study concludes that waiting overnight in the ED for admission to a ward poses a significant risk to older patients. It is associated with increased in-hospital mortality and morbidity, particularly in patients with limited autonomy. As a result, older adults should be prioritized for admission to a ward to reduce these risks and provide them with more appropriate care and monitoring.

These findings have implications for healthcare systems and emergency departments, emphasizing the need to expedite the admission process for older adults to reduce the time they spend in the ED.

Reference:

Roussel, M., Teissandier, D., Yordanov, Y., Balen, F., Noizet, M., Tazarourte, K., Bloom, B., Catoire, P., Berard, L., Cachanado, M., Simon, T., Laribi, S., Freund, Y., Abou-Badra, M., Addou, S., Allione, É., Bard, A.-S., Beaune, S., Bernas, F., … FHU IMPEC−IRU SFMU Collaborators. Overnight stay in the emergency department and mortality in older patients. JAMA Internal Medicine,2023. https://doi.org/10.1001/jamainternmed.2023.5961