Overnight Stay in the Emergency Department and Mortality in Older Patients
Mélanie Roussel, Dorian Teissandier, Youri Yordanov, Frédéric Balen, Marc Noizet, Karim Tazarourte, Ben Bloom, P. Catoire, Laurence Bérard, Marine Cachanado, Tabassome Simon, Sai͏̈d Laribi, Yonathan Freund, FHU IMPEC−IRU SFMU Collaborators, Mathieu Abou-Badra, Sarah Addou, Émilie Allione, Anne-Sophie Bard, Sébastien Beaune, F. Bernas, Romain Blondet, Anne Bouchara, Alice Boulanger, Arthur Bourg, C. Broche, L. A. Machado Cesar, Anthony Chauvin, Alban Chauvineau, Richard Chocron, Tahar Chouihed, Yann Erick Claessens, Pierre Géraud Claret, Julie Contenti, Carole Cornaglia, Valérie Debierre, Marion Douplat, J. Duchenne, Odile Dumont, Romain Durif, J Fabre, Anne Laure Feral, Quentin Foubert, Hadrien Friedel, Anne Marie Gangneron, Maxime Gautier, Émilie Gelin, Camille Gerlier, Cédric Gil Jardine, Anaïs Girard, Séverine Gosselin, Sylvie Grgek, M. Guerin, Baroan Bertin Guina, Mélanie Halaoui, Lionel Imsaad, Laure Jainsky, Didier Jammes, Mehdi Khellaf, Melek Sunde Kilic, Gilles Kleiner, J. Wayne Lazar, Pierrick Le Borgne, Adrien Le Brozec, Anne Le Coat, Catherine Le Gall, Sophie Lefebvre, Delphine Levy, Marie Emmanuelle Limoges, Théophile Lormier, Richard Macrez, Anne Mahier, Bastien Malossane, Nicolas Marjanovic, S. Massacrier, Emmanuel Montassier, Benoit Morel, Céline Moretto, Nesrine Nabli, Eloi Nenert, Céline Occelli, Laurent Ortega, Xavier Pereira, Nicolas Persico, Helene Pizzut-Mardegan, Annie Porte, Ludivine Quay, Diana Rafidiniaina, Agnès Ricard-Hibon, Julie Rosenblatt, Dominique Savary, H. R. Schmidt, Bertrand Sorin, Ombeline Susong, Nicolas Termoz Masson, E. Thibaud, Ayoub Touihar, Jennifer Truchot, Prabakar Vaittinada Ayar, Camille Vennetier, Frédéric Verbois
Abstract
Importance: Patients in the emergency department (ED) who are waiting for hospital admission on a wheeled cot may be subject to harm. However, mortality and morbidity among older patients who spend the night in the ED while waiting for a bed in a medical ward are unknown. Objective: To assess whether older adults who spend a night in the ED waiting for admission to a hospital ward are at increased risk of in-hospital mortality. Design, Settings, and Participants: This was a prospective cohort study of older patients (≥75 years) who visited the ED and were admitted to the hospital on December 12 to 14, 2022, at 97 EDs across France. Two groups were defined and compared: those who stayed in the ED from midnight until 8:00 am (ED group) and those who were admitted to a ward before midnight (ward group). Main Outcomes and Measures: The primary end point was in-hospital mortality, truncated at 30 days. Secondary outcomes included in-hospital adverse events (ie, falls, infection, bleeding, myocardial infarction, stroke, thrombosis, bedsores, and dysnatremia) and hospital length of stay. A generalized linear-regression mixed model was used to compare end points between groups. Results: The total sample comprised 1598 patients (median [IQR] age, 86 [80-90] years; 880 [55%] female and 718 [45%] male), with 707 (44%) in the ED group and 891 (56%) in the ward group. Patients who spent the night in the ED had a higher in-hospital mortality rate of 15.7% vs 11.1% (adjusted risk ratio [aRR], 1.39; 95% CI, 1.07-1.81). They also had a higher risk of adverse events compared with the ward group (aRR, 1.24; 95% CI, 1.04-1.49) and increased median length of stay (9 vs 8 days; rate ratio, 1.20; 95% CI, 1.11-1.31). In a prespecified subgroup analysis of patients who required assistance with the activities of daily living, spending the night in the ED was associated with a higher in-hospital mortality rate (aRR, 1.81; 95% CI, 1.25-2.61). Conclusions and Relevance: The findings of this prospective cohort study indicate that for older patients, waiting overnight in the ED for admission to a ward was associated with increased in-hospital mortality and morbidity, particularly in patients with limited autonomy. Older adults should be prioritized for admission to a ward.