Long emergency waiting times linked to increased risk of adverse events

June 2, 2011, British Medical Journal

Long emergency department waiting times are associated with an increased risk of hospital admission or death within seven days among non-admitted patients, finds a study published in the British Medical Journal today.

The findings support policies to reduce the time patients wait and call into question government plans to abandon the 4-hour A&E target in England for lack of "clinical justification."

Long waiting times are associated with delays in care and several countries have set targets for the time patients wait. Most (85%) of emergency department patients go home after their visit, but whether waiting times adversely affect their outcomes is unknown.

So researchers in Canada set out to determine whether patients who present to emergency departments during shifts with long waiting times are at for (hospitalisation or death within seven days).

Using data from high volume emergency departments in Ontario, Canada from 2003-2007, they identified 13,934,542 "seen and discharged" patients and 617,011 "left without being seen" patients.

Risk of short term adverse events increased with average emergency department length of stay.

Although the overall risk is low, risk of increased by up to 95% while risk of death increased by up to 79% among the sickest patients.

Risk of death increased incrementally with each additional hour of average shift waiting time and the authors calculate that reducing emergency department length of stay by one hour, on average, could have potentially cut the number of deaths in this study in higher risk patients by 558 (6.5%) and in lower risk patients by 261 (12.7%).

Contrary to popular belief, patients who left without being seen were not at higher risk of short term adverse events compared with patients who were seen and discharged, nor were patients who attended emergency departments with high "left without being seen" rates.

This is reassuring, say the authors, as there has been much uncertainty surrounding outcomes of "left without being seen" . However, these results suggest that presenting to emergency departments during shifts with long average waiting times may have serious patient safety implications.

They argue that there is likely clinical justification to reduce emergency department and they call into question recently announced plans to abandon English emergency department targets.

In an accompanying editorial, Melissa McCarthy, Associate Professor at George Washington University in the US writes: "We need to extend the evaluation of emergency care to either the resolution of the problem or transfer of care to a provider better suited to tackle the patient's needs."

She believes that emergency departments must be redesigned to meet patients' needs more effectively and efficiently. Ongoing measurement of patient outcomes is also essential, she says, as is seamless integration between the and hospital and a stronger linkage to ambulatory care providers to enhance delivery of care and clinical effectiveness.

Explore further: Re-admission rates via emergency rooms climbing among patients who have recently been hospitalized

Related Stories

Re-admission rates via emergency rooms climbing among patients who have recently been hospitalized

June 1, 2011
Emergency department patients who have recently been hospitalized are more than twice as likely to be admitted as those who have not recently been in the hospital, according to new research from the Perelman School of Medicine ...

Recommended for you

Marijuana use does not lower chances of getting pregnant

January 22, 2018
Marijuana use—by either men or women—does not appear to lower a couple's chances of getting pregnant, according to a new study led by Boston University School of Public Health (BUSPH) researchers.

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.