Older Patients Face Higher Risk of Death if They Spend the Night in ER, Study Warns

According to the findings of a new study, individuals over the age of 75 face a higher risk of death if they spend the night in the emergency room, as opposed to being directly admitted to the hospital ward.

In a report published this week in the medical journal JAMA Internal Medicine, French researchers indicate that older patients with mobility issues fare better if they are transferred to a hospital ward for overnight care, where they can receive focused medical care instead of staying in the ER.

The researchers conducted a cohort study of 1,600 patients 75 years and older with a limited ability to care for themselves, who were treated across 97 emergency rooms in France. They compared patients who were initially treated in the ER, but transferred to a hospital ward before midnight, to patients who stayed in the ER to receive care past midnight until the morning. Those patients stayed in a wheeled cot during the overnight stay.

The findings indicate the in-hospital death rate was 16% among patients who stayed in the ER overnight, compared to 11% among patients who were transferred to another hospital ward.

Older patients who stayed in the ER also had a longer hospital stay overall. They were hospitalized for nine days compared to eight days on average for patients who were transferred to a hospital ward.

Patients who had limited mobility or needed help doing daily tasks on their own were found to be particularly at risk.

“These findings suggest that older patients, particularly those with limited autonomy, who spend the night in the [emergency room] awaiting hospital admission may have a higher risk of in-hospital mortality and morbidity; they should be prioritized for admission to a ward,” the researchers determined.

Emergency Room Risks for Older Patients

Researchers report that patients who stayed in the ER had a higher risk of suffering adverse events, including falls, infections, bleeding, myocardial infarction, strokes, thrombosis, bedsores, and dysnatremia; a severe electrolyte imbalance that is difficult for older patients to recover from.

Some of these adverse events, including infections, heart attacks, strokes and falls, were found to contribute to patients’ deaths. They also were treated in what the study authors called wheeled cots, which were portable hospital beds.

Patients in the ER also have less privacy and are one of many other patients the staff is tending, the researchers noted. Many ERs treat hundreds to thousands of patients each day, especially during overnight shifts. Patients who don’t require urgent care are often overlooked until they need emergency care.

Patients who are transferred to a hospital ward have a lower staff-to-patient ratio, which offers improved care, the findings indicate. They also receive more attentive care for conditions they suffer from that make them less mobile.

Researchers indicated the findings highlight a need for prioritizing the transfer of older patients, especially those with limited function. Admission to a hospital ward instead of keeping older patients in the ER for extended periods or overnight can help reduce the risk of death and adverse events overall, potentially also reducing hospital costs, they concluded.