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Is Delayed Admission Deadly?

April 12, 2022

Written by Vivian Lei

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This large study shows that all-cause 30-day mortality increases with delayed hospital admission from the ED, starting at 5 hours after patient arrival.

Why does this matter?
Longer stays in the ED result from a range of factors, including patient acuity, treatment decision-making times, and systems-level issues of staffing and crowding. Although this paper does not show causality, it reflects a sobering reality in which each minute of delay in admission from the ED appears to have a dose-dependent relationship with increased risk of death at 30 days.

Delayed admission is deadly for patients
This was a cross-sectional, comparative, retrospective, observational study conducted within a large NHS database of all patients admitted to the hospital from EDs in England between April 2016 and March 2018. Times were measured from a patient’s arrival in the ED until their transfer to an inpatient bed. Researchers evaluated a primary outcome of death from any cause within 30 days. Overall, 30-day mortality was 8.71%. Using a standardized mortality rate (SMR = observed/expected deaths) charted against time in the ED, they found an increased SMR for patients in the ED longer than 5 hours. The SMR increased linearly thereafter in a dose-dependent manner such that the death rate was 8% higher than expected among patients waiting 6-8 hours and 10% higher than expected for those waiting 8-12 hours, compared with patients leaving the ED within 6 hours. Authors calculate a number needed to harm, showing that one excess death will occur for every 82 patients who are delayed admission for more than 6-8 hours.

There are many potential confounding factors, only some of which are adjusted for by the study model. Nevertheless, it is clear that whatever leads a patient to stay longer in the ED is associated with an increased risk of death. This has clear implications for clinical practice, future research, and healthcare policy.

Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Emerg Med J. 2022 Mar;39(3):168-173. doi: 10.1136/emermed-2021-211572. Epub 2022 Jan 18.

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