Long emergency waiting times linked to increased risk of adverse events

June 2, 2011

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

To combat teen smoking, health experts recommend R ratings for movies that depict tobacco use

July 21, 2017
Public health experts have an unusual suggestion for reducing teen smoking: Give just about any movie that depicts tobacco use an automatic R rating.

Aging Americans enjoy longer life, better health when avoiding three risky behaviors

July 20, 2017
We've heard it before from our doctors and other health experts: Keep your weight down, don't smoke and cut back on the alcohol if you want to live longer.

Opioids and obesity, not 'despair deaths,' raising mortality rates for white Americans

July 20, 2017
Drug-related deaths among middle-aged white men increased more than 25-fold between 1980 and 2014, with the bulk of that spike occurring since the mid-1990s when addictive prescription opioids became broadly available, according ...

Parents have critical role in preventing teen drinking

July 20, 2017
Fewer teenagers are drinking alcohol but more needs to be done to curb the drinking habits of Australian school students, based on the findings of the latest study by Adelaide researchers.

Fresh fish oil lowers diabetes risk in rat offspring

July 19, 2017
Fresh fish oil given to overweight pregnant rats prevented their offspring from developing a major diabetes risk factor, Auckland researchers have found.

High-dose vitamin D doesn't appear to reduce the winter sniffles for children

July 18, 2017
Giving children high doses of vitamin D doesn't appear to reduce the winter sniffles, a new study has found.

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.