According to research published in the British Medical Journal, “England had at least 4519 excess deaths in England in 2020-21 as a result of overcrowding and stays of 12 hours or longer in emergency departments, an analysis by the Royal College of Emergency Medicine has found”.
Adrian Boyle, vice president (policy) of the Royal College of Emergency Medicine, commented:
The figure was calculated from findings from the NHS’s Getting It Right First Time (GIRFT) programme and Hospital Episode Statistics (for 2020-21), which measure numbers of stays of 12 hours from time of arrival.
“To say this figure is shocking is an understatement. Quite simply, crowding kills. For many years we have issued warnings about the harm that dangerous crowding causes, but now we can see the number of excess deaths that have occurred as a result.”
He said October 2021 saw an “unimaginable” 7059 stays of 12 hours from the time of decision to admit, the highest number ever recorded.
“The number of 12 hour stays has risen drastically for six months and is very likely to rise again in the coming months,”
“The picture is more bleak, as hospital episode statistics show that 12 hour stays from time of arrival are 21 times higher than 12 hour DTA [decision to admit] stays. We now know that at least one in 67 of these patients are coming to avoidable harm. It is appalling.”
Matthew Taylor, chief executive of the NHS Confederation, commented on the report:
“Overcrowding in emergency departments is not merely inconveniencing patients during their visits to hospital, it’s costing thousands of lives.
“This report again shows why healthcare leaders are sounding the alarm, with the health service now under critical and unsustainable pressure.”
The Impact of Poorly Functioning A & E Departments
Dr Tim Cooksley, president of the Society for Acute Medicine, has said that the country’s healthcare system “is becoming increasingly compromised” as A & E departments struggle to cope.
Dr Cooksley said:
“We are seeing overcrowding in acute care settings with patient flow throughout the system impaired,”and that problems in A & E departments were “exacerbated by high staff absence levels, fatigue, and low staff morale, worsened by often not being able to deliver the standard of care they wish.”
The impact of serious delays in A& E departments may lead to:
- Longer waiting times for ambulances
- Poor health outcomes for patients as important, and often life-saving treatment, could be delayed
- The risk of serious and permanent damage to, nerves, tissues and organs may be increased
- Increasing risk of hospital-acquired infections
- Patients may require longer stays in hospital and more the need for intensive care
- Longer recovery times for patients
- More Pressure on hospital staff and surgical units
Dr Cooksley called for “prioritisation of staffing in emergency departments and acute medical units to safe levels across teams to support assessments and treatment.”
Waiting More Than 5 Hours in A& E Linked to Increased Risk of Death, Study Finds
According to research findings published in the Emergency Medicine Journal, waiting more than 5 hours in an A & E department – before hospital admission – was linked to an increased risk for death from any cause in the 30 days that followed.
- The death rate was 8% higher than expected among those patients waiting between 6-8 hours before admission to hospital, and 10% higher than expected for those waiting 8-12 hours, compared with patients being seen within 6 hours.
- The researchers concluded that there was 1 extra death for every 82 patients delayed after 6-8 hours and 1 extra death for every 72 patients waiting in A&E for 8- 12 hours.
*ED: Emergency Department / A & E
Graph source: Healio. Research: Jones S, et al. Emerg Med J. 2022;doi:10.1136/emermed-2021-211572.
Chris Moulton, an author of the study and consultant in emergency medicine in the A & E department at the Royal Bolton Hospital in England and the vice president of the Royal College of Emergency Medicine, and colleagues wrote:
“The results from this study show that there is a ‘dose-dependent’ association between time in excess of 5 hours in the ED for admitted patients and their all-cause 30-day mortality,”
Moulton and colleagues conducted an observational study of patients who were admitted at major A & E departments in England between April 2016 and March 2018.
The researchers reviewed Hospital Episode Statistics and Office of National Statistics data for England, covering every patient admitted to hospital from each major (type 1) A & E department in England. The study looked into the associated risk for death from delays in inpatient admission from A & E departments.
Keynotes from the study:
- 7,472,480 patient admissions representing 5,249,891 individual patients sought care at an A & E department (type 1) during the study period.
- The average wait time was “just under 5 hours,” according to the researchers. However, 38% of patients waited more than 4 hours for admission and 3% of patients waited for more than 12 hours.
- Their mean age was 50.27 years and 52% were women.
- Risk association was based on a patient’s first hospital admission.
- Potentially influential risk factors were adjusted in the risk assessment.
Commenting on the study, Dr Katherine Henderson, president of the Royal College Emergency Medicine, said in a statement:
“We welcome this paper, which adds to the evidence of what we have long warned – that long-waiting times present a serious threat to patient safety.
“Performance in Emergency Departments has been in decline for many years now, while waiting times have risen significantly; the risk to patient safety is a growing problem. It is unacceptable and deeply concerning. No patient should be kept waiting to be admitted to a bed”.
Also in response to the study, Dr Simon Walsh, BMA consultants’ committee deputy chair and emergency medicine consultant, said:
“Performance against the 4-hour target over recent months has been the worst recorded since it was introduced and this paper shows that the longer patients wait, the greater their risk of death. The study used data from before the pandemic started and sadly, we know that more patients are now waiting much longer than the target of 4 hours, with a huge increase in the number who are waiting over 12 hours to be seen and admitted.
“This exit block from emergency departments, caused by a lack of any spare capacity in hospitals, also leads to delayed ambulance handovers, sometimes for several hours, with devastating effects on ambulance response times also resulting in harm to patients.”
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