Long waits in A&E departments ‘increase risk of dying within 30 days’

Patients who spend longer in A&E departments waiting for non-immediate care could have a higher risk of dying within the first few weeks of being discharged, research suggests.

The risk of dying within 30 days of leaving A&E in England is likely to be more than twice as high for someone whose visit lasted 12 hours than someone who was there for just two hours.

The odds may be even higher for certain groups of the population, including young adults or people who went to A&E for reasons to do with their eyes.

The findings have been published by the Office for National Statistics (ONS) and are based on data for A&E attendances in England from March 2021 to April 2022, when the Covid-19 pandemic was still under way.

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Hospitals implemented a range of measures during the pandemic to control the spread of infection and these may have affected the way A&E departments operated.

Such measures are unlikely to be in place to the same extent today, meaning the results of the research do not necessarily reflect the current risk of dying after visiting A&E, the ONS said.

The findings cover only patients who required non-immediate care in an emergency department.

They suggest that, when compared with people who spent two hours in A&E, the odds of a post-discharge death within 30 days were 1.1 times higher for those who were there for three hours, 1.6 times higher for those whose visit lasted six hours and 2.1 times higher for those who were there for 12 hours.

The relative difference in the risk of post-discharge death after 12 hours in A&E compared with two hours was greatest for younger patients, with the odds being 4.6 times higher for 20-year-olds.

It was also greater for those in London (2.7 times higher), those who attended A&E for reasons to do with their eyes (7.9 times higher) and those who were not admitted to hospital for inpatient care after visiting A&E (2.8 times higher).

Daniel Ayoubkhani, ONS head of health research, said: “Today’s release builds on previous research to demonstrate that time spent in A&E may be an important risk factor for dying after being discharged, and not just during the patient’s visit.

“During the time period covered by the study, patients who spent longer in A&E for non-immediate care had a higher risk of dying within 30 days of being discharged, even accounting for a wide range of socio-demographic and clinical factors.

“Our analysis of linked health records for 6.7 million individuals in England indicates that the risk of dying within 30 days of leaving A&E was more than twice as high for someone who spent 12 hours in A&E compared with two hours.”

Excluding those who died while still at hospital, 1.3% of people who attended A&E in England between March 21 2021 and April 30 2022 died within 30 days of leaving to return home or be admitted to inpatient care.

Not all factors related to time spent in A&E and 30-day post-discharge mortality could be reflected in the research.

Statisticians did not have data on over-crowding, while some patients are likely to have waited longer because they needed access to specialist treatments, advice or services.

“Our results therefore only relate to statistical associations; we cannot say with certainty whether longer times spent in A&E cause higher rates of post-discharge mortality,” the ONS added.

Responding to the findings, Professor Julian Redhead, NHS national clinical director for urgent and emergency care said: “We know there is a real impact when patients wait too long in A&E.

“This is a result of pressure across health and social care, including record A&E and GP attendances, challenges discharging patients from hospital, and wards routinely operating at close to 100% capacity.

“In response we have rolled out a number of services including virtual wards so patients can be supported from the comfort of their home, same day emergency care centres so patients arriving at A&E are seen quicker and discharged on the same day – while latest data shows the NHS has more beds opened than this time last year.

“However more needs to be done to support patients and hard-working NHS staff, and we will work with government to develop further plans to improve urgent and emergency care, including shifting more care to community settings as part of the 10 Year Health Plan.”

Dr Tim Cooksley, immediate past president of the Society for Acute Medicine, said: “This important data from the ONS further illustrates the importance of timely acute care and the harm caused from prolonged waits – succinctly and sadly the early death of many people.

“This is a personal tragedy for too many families.

“It is impossible to over-emphasise that this number will be rising. Those waiting for 12 hours in emergency departments are increasing. The overcrowding and impacts of this will invariably have resulted in a greater number of avoidable deaths in the last 12 months.

“The lack of dignity for patients and the appalling impact on nursing colleagues was starkly and harrowingly described in the Royal College of Nursing report earlier this week.

“The situation is currently worsening and the opportunity to alter the direction of travel is increasingly narrow. If government ministers aren’t asleep at the wheel as opposition MPs have recently suggested; they need to prove it.”

The Royal College of Nursing published new findings this week on the condition of the hospitals in England, including accounts of patients dying in corridors and sometimes going undiscovered for hours, and of sick people being left to soil themselves.