Overnight Stay in the Emergency Department and Mortality in Older Patients
Authors: Roussel Melanie , Teissandier Dorian , Yordanov Youri , Balen Frederic , Noizet Marc , Tazarourte Karim , Bloom Ben , Catoire Pierre , Berard Laurence , Cachanado Marine , Simon Tabassome , Laribi Said , Freund Yonathan ,   FHU IMPEC−IRU SFMU Collaborators, Abou-Badra Mathieu , Addou Sarah , Allione Émilie , Bard Anne-Sophie , Beaune Sébastien , Bernas Florian , Blondet Romain , Bouchara Anne , Boulanger Alice , Bourg Arthur , Broche Claire , Cesar Laetitia , Chauvin Anthony , Chauvineau Alban , Chocron Richard , Chouihed Tahar , Claessens Yann Erick , Claret Pierre Géraud , Contenti Julie , Cornaglia Carole , Debierre Valérie , Douplat Marion , Duchenne Jonathan , Dumont Odile , Durif Romain , Fabre Jean , Feral Anne Laure , Foubert Quentin , Friedel Hadrien , Gangneron Anne Marie , Gautier Maxime , Gelin Émilie , Gerlier Camille , Gil jardine Cédric , Girard Anaïs , Gosselin Séverine , Grgek Sylvie , Guerin Magali , Guina Baroan Bertin , Halaoui Mélanie , Imsaad Lionel , Jainsky Laure , Jammes Didier , Khellaf Mehdi , Kilic Melek Sunde , Kleiner Gilles , Lazar Julien , Le Borgne Pierrick , Le Brozec Adrien , Le Coat Anne , Le Gall Catherine , Lefebvre Sophie , Levy Delphine , Limoges Marie Emmanuelle , Lormier Théophile , Macrez Richard , Mahier Anne , Malossane Bastien , Marjanovic Nicolas , Massacrier Sylvie , Montassier Emmanuel , Morel Benoit , Moretto Céline , Nabli Nesrine , Nenert Eloi , Occelli Céline , Ortega Laurent , Pereira Xavier , Persico Nicolas , Pizzut-Mardegan Helene , Porte Annie , Quay Ludivine , Rafidiniaina Diana , Ricard-Hibon Agnès , Rosenblatt Julie , Savary Dominique , Schmidt Hugo , Sorin Bertrand , Susong Ombeline , Termoz Masson Nicolas , Thibaud Éric , Touihar Ayoub , Truchot Jennifer , Vaittinada Ayar Prabakar , Vennetier Camille , Verbois Frederic , Viard Thibault , Wargon Mathias , Youssef Mustapha , Zamour Claude 
Published: November 2023

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.