The Irish Association for Emergency Medicine wants to highlight an important paper published last week in JAMA, a leading medical journal, that shows that for every 21 older patients kept overnight in an Emergency Department awaiting a ward bed, there is 1 extra death at 30 days. This information comes from a multi-centre study done by the Sorbonne University in Paris that included 97 hospitals.
This is stark. The medical scientific literature has consistently highlighted that keeping patients in crowded Emergency Departments on trolleys is associated with increased deaths. Previous work from the UK showed that for every 82 patients delayed in the Emergency Department greater than 6 hours there was 1 excess death. The JAMA paper focused on older adults; it shows an even greater risk to life for this group and highlights that older patients with limited autonomy are even more at risk.
Doctors working in Emergency Departments have been highlighting the harm associated with crowding and prolonged waits on Emergency Department trolleys for inpatient beds in Ireland for 2 decades. We see first hand the negative impact that crowded, noisy, brightly lit Emergency Departments have on sick patients, in particular, on older adults. We see these patients deteriorate before our eyes; emergency medical and nursing personnel are repetitively experiencing moral injury resulting from their witnessing substandard care due to the lack of Acute Hospital bed capacity.
For a bed to be available in the Acute Hospital for an older patient, there needs to be an adequate number of Acute Hospital beds. In Ireland presently, there are not enough Acute Hospital beds. This dire situation is made worse as there are also inadequate numbers of Rehabilitation Beds, Long Term Care Beds or Community Support Services available. This means Acute Hospital beds, designed for our sickest patients and not designed for the needs of the patient requiring long term careare being used as Rehabilitation and Long Term Care Beds and as a substitute for homecare packages. Meanwhile, the most acutely sick patients do not have an Acute Hospital bed to go to and get stuck on a trolley in the Emergency Department.
This government, during its remaining tenure, has the opportunity to effect life-saving change by both investing in Acute Hospital bed capacity and expanding Rehabilitation and Community beds and supports. Given the scientific evidence of excess deaths associated with the lack of bed capacity, an extraordinary effort is needed to right this wrong being inflicted on our patients, in particular our older patients. Tribunals of enquiry into how and why we allowed patients be treated in this way will inevitably look back in shame at this period in our history. A meaningful widespread investment in beds to bring us in line with other OECD countries cannot wait any longer.
Overnight Stay in the Emergency Department and Mortality in Older Patients.
Roussel M, et al. JAMA Intern Med. 2023 Nov 6:e235961. doi: 10.1001/jamainternmed.2023.5961. Online ahead of print. PMID: 37930696
