"The groundwork of all happiness is health." - Leigh Hunt

Overnight stays within the emergency room increase the chance of death for older patients

November 15, 2023 – Older individuals who wait overnight within the emergency room resulting from a hospital bed shortage are at higher risk of dying or developing recent health problems during their stay, in keeping with a significant recent study.

The Results by French researchers were published within the journal this month JAMA Internal Medicine. The evaluation included 1,598 people ages 75 and older who visited emergency rooms and stayed overnight while waiting to be admitted to a hospital. The average age of the study participants was 86 years. Researchers compared the outcomes of two groups: those that stayed within the emergency room from midnight to eight a.m. and those that were hospitalized before midnight.

Co-author Yonathan Freund, MD, PhD, called the study period in December 2022 a “special time” as Europe, just like the United States, was experiencing a triple pandemic of influenza, COVID-19 and respiratory syncytial virus (RSV). This emerges from a podcast interview that was published along with the study results.

“We had a huge increase in elderly patients who needed hospital beds, and of course there weren't enough,” said Freund, a practicing doctor in Paris and professor at France's Sorbonne University.

The evaluation found that folks who stayed overnight within the emergency room died during their hospital stay at a 40% higher rate than people admitted to a room before midnight. The mortality rate for individuals who stayed overnight within the emergency room was 15.7%, in comparison with 11.1% for individuals who got a room before midnight.

The increased mortality rate during hospital stays after an overnight stay within the emergency room was particularly higher in individuals who weren’t fully independent, meaning they needed help with on a regular basis activities.

People who spent the night within the emergency room were also more prone to produce other health problems during their hospital stay than those admitted before midnight. Overnight stays within the emergency room were related to a 24% increased risk of latest health problems. The recent problems the researchers searched for included falls, infections, bleeding, heart attacks, strokes, pressure sores and blood clots.

People who didn't get an overnight room within the hospital and as an alternative stayed within the emergency room were more prone to stay within the hospital longer than individuals who were admitted before 12 p.m.

Before the COVID-19 pandemic, 90% of U.S. emergency rooms often reported overcrowding, and wait times averaged greater than 2.5 hours in 2022, a study found comment published parallel to the study.

The recent findings suggest several options for emergency departments and hospitals to make improvements, wrote commentary authors Timothy S. Anderson, MD, MAS, of the University of Pittsburgh, and Shoshana J. Herzig, MD, MPH, of Harvard Medical School .

They suggested creating recent departments in emergency departments which are less stressful and looking out at staffing to observe people waiting in emergency departments who’re considered stable but are only awaiting hospitalization. A 3rd area to think about is hospital staffing changes that might improve discharge flow and thereby reduce bed shortages. Another option that might change the “flow” of patients is using “discharge lounges” to unencumber space, they said.