Waiting at least six hours in A&E before being admitted to hospital can raise your risk of dying by almost 10 per cent, a damning report suggests.
According to the NHS, 95 percent should be seen by patients within 4 hours of arriving at casualty units. The health system has failed repeatedly to achieve its goals.
Around one million patients faced four-hour waits in 2021, with A&E units now seeing just 73 per cent of patients in the recommended time-frame.
Now, researchers from the Royal Bolton Hospital have analysed 5millionA&E visits to calculate the potential cost in lives caused by treatment delays.
Patients forced to wait at least six hours between attending A&E and being admitted for treatment were 8 per cent more likely to die within 30 days. For every 82 patients with severe delays, there was an additional death.
For patents that were granted after eight hours or more, the risk of death rose to 10%
According to researchers, the increase in mortality may be caused by a number of factors. These include delayed critical care, prolonged hospital stays, delayed admissions, and patients admitted late at night because staffing levels are low.
Lengthy A&E waits have grown more common over the course of the pandemic due to backlogs of care and staffing problems in the NHS.
Today, emergency medics warned that the unacceptable delays pose a serious threat to patient safety. However, NHS leaders are planning to eliminate the target of four hours.
Research by the Royal College of Emergency Medicine shows that patients who wait longer in emergency rooms for treatment have a higher chance of dying within 30 days. In the graph above, the dotted line indicates that there is a threshold at which an increased death risk. This increases from around the 5 hour mark.
England’s A&E departments have struggled for years to meet a target to have 95 per cent of patients either starting treatment of discharged within four hours
Researchers used data from 5million A&E patients in England who attended a major emergency department and were admitted to hospital in England between April 2016 and May 2018.
These patients were then compared with deaths recorded within the first 30 days of admission. Researchers also considered factors such as gender, age and other medical conditions.
The study’s lead author, Dr Chris Moulton stated that delays can have a far greater impact than simply death.
He said that the study failed to account for the effects of delays on patients or for the awful experience of waiting in line for care.
He said that 30-day mortality is an insufficient metric to account for increases in patient morbidity and for the inevitable worsening patient experience.
The research, published in the Emergency Medicine Journal, was an observational study and, therefore, cannot directly link an extended treatment to a patient death.
Dr Moulton however stated, “From a clinical standpoint it makes sense that there is a link.”
“Despite the lack of supporting evidence,” he stated, “There are many clinically plausible reasons for accepting that there is an association between delayed hospitalization and poorer outcomes.”
There are many reasons for this, including the delay in vital treatments that results in a prolonged hospital stay. This increases the chance of patients contracting a hospital-acquired infection.
Researchers also suggested that patients who are delayed are more likely be admitted at night to hospitals when there are no beds available and staffing is at its lowest.
Dr Moulton said that the study demonstrates the importance of decreasing wait times in treatment. He also stated, “Should continue requiring timely admission from an emergency department” to ensure patients are protected from harm from hospitals.
In a statement for the release of the study, RCEM lay member Derek Prentice said: ‘Let nobody be in doubt any longer, the NHS four-hour operational target is, as many of us have always known, of key importance to patient safety.’
The latest statistics for the all of NHS England’s emergency departments recorded that just 73 per cent of A&E patients were seen within the NHS’ four-hour target with performance having steadily declined since 2010
The college’s president, Dr Katherine Henderson, also welcomed the research, saying it confirmed what all A&E colleagues know, that long waiting-times threaten patient safety.
The government should now address the “exit block” issue. This is where patients are unable to get in as they wait for their discharge from a failing social care system.
She stated that ‘To achieve this, long-term resourcing is required; the government must publish a long–term workforce plan for health services and implement effective measures to address the ongoing crisis in social care.
Dr Henderson also bemoaned the current lack of clarity for A&E performance in England with the Government planning to phase out the four-hour target and replace with, as yet, ill-defined metrics.
We are in a performance vacuum. Staff don’t know what to focus on. Month-on month, performance drops. Inaction is the answer. Patients and their care suffer the most,” she stated.
One spokesperson from the NHS stated that the NHS was under pressure. Between 2016 and 2018, there were more than 26million visits to the emergency rooms. The additional challenges caused by the pandemic mean that staff of the NHS work hard to meet the rising demands and to deliver expert care to all patients.
For comment, we reached out to Department of Health.
The four-hour target time for 95 per cent of people to be seen when attending A&E was introduced in 2004.
NHS England had announced that in May 2012, it was replacing the pack with 10 new measures.
They include performance indicators such as the percentage of patients who are transferred by ambulances or receive initial assessment within fifteen minutes.
And instead of a four-hour performance target A&Es would instead publish the average time spent in emergency departments before either being admitted or discharged.
The exact details of these measures, as well as when and where they will come into effect, have not been announced. However, NHS England is still in discussions with the Department of Health about their implementation.