Key points Is spending an overnight stay in the emergency department (ED) associated with increased in-hospital mortality and morbidity among older patients? Findings This French cohort study of 1,598 patients aged 75 years or older , those who spent one night in the emergency department, showed a higher in-hospital mortality rate and a higher risk of adverse events compared to patients admitted to a ward. Before midnight. This finding was particularly notable among patients with limited autonomy. Meaning These findings suggest that older patients, particularly those with limited autonomy, who spend the night in the ED awaiting hospital admission may be at increased risk for in-hospital mortality and morbidity; They should be given priority for admission to a ward. |
Importance
Patients in the emergency department (ED) awaiting admission to the hospital on a stretcher with wheels may be harmed. However, mortality and morbidity among older patients who spend the night in the ED while waiting for a bed in a medical ward is unknown.
Aim
To evaluate whether older adults who spend a night in the emergency department waiting to be admitted to a hospital ward have an increased risk of in-hospital mortality.
Design, environments and participants
This was a prospective cohort study of older patients (≥75 years) who visited the emergency department and were admitted to hospital from December 12 to 14, 2022, in 97 emergency departments across France.
Two groups were defined and compared:
- Those who remained in the emergency department from midnight to 8:00 am (emergency group).
- Those who entered a room before midnight (room group).
Main results and measures
The primary endpoint was in-hospital mortality , truncated at 30 days.
Secondary outcomes included in-hospital adverse events (i.e., falls, infection, hemorrhage, myocardial infarction, stroke, thrombosis, bedsores, and dysnatremia) and length of hospital stay.
A generalized linear regression mixed model was used to compare endpoints between groups.
Results
The total sample consisted of 1,598 patients (median age [IQR], 86 [80-90] years; 880 [55%] women and 718 [45%] men), with 707 (44%) in the ED group. and 891 (56%) in the neighborhood group.
Patients who spent the night in the ED had a higher in-hospital mortality rate , 15.7% versus 11.1% (adjusted risk ratio [aRR], 1.39; 95% CI, 1 .07-1.81).
They also had a higher risk of adverse events compared with the ward group (aRR, 1.24; 95% CI, 1.04-1.49) and a longer median length of hospital stay (9 vs. 8 days ; rate ratio, 1.20; 95% CI, 1.11-1.31).
In a prespecified subgroup analysis of patients requiring help with activities of daily living, an overnight stay in the ED was associated with a higher in-hospital mortality rate (aRR, 1.81; 95% CI, 1.25). -2.61).
Conclusions and relevance Findings from this prospective cohort study indicate that for older patients, waiting overnight in the ED to be admitted to a ward was associated with increased in- hospital mortality and morbidity , particularly in patients with limited autonomy. Elderly adults should be given priority to enter a room. |
