Patients who face extended waits in Accident & Emergency (A&E) departments after fracturing a hip may be at a higher risk of death, according to a recent study. The study also revealed that patients who endure waits of over four hours in A&E are more likely to have a prolonged hospital stay. Researchers analysed data from hip fracture patients aged 50 and above at a trauma centre in Lothian, Scotland, spanning from January 2019 to June 2022. Among the 3,266 patients studied, with an average age of 81 years and 72% female, 38.6% spent more than four hours in A&E. Over a follow-up period exceeding 500 days, 1,314 patients passed away.
The research showed that patients who spent more than four hours in A&E had significantly lower odds of still being alive three months after hospital admission compared to those with shorter A&E stays. Specifically, those who waited over four hours had a 36% higher chance of dying within 90 days following their hip break, in comparison to those with shorter A&E wait times. The study suggested that for every 36 patients who waited longer than four hours in the emergency department, there was one additional death at 90 days. Furthermore, the delay was linked to an extra day spent in the hospital on average for patients who waited longer than four hours.
It is estimated that about one-third of females and 17% of males over the age of 80 will experience a hip fracture, with rates projected to rise, as noted by the authors in the Emergency Medicine Journal. In response to these findings, the Royal Infirmary of Edinburgh has implemented a new “fast track” service to ensure the majority of hip fracture patients wait no more than two hours in the A&E. Lead author Dr. Nicholas Clement, from the Royal Infirmary of Edinburgh and the University of Edinburgh, explained that a fast track care pathway has been developed to minimise the time patients spend in the emergency department, as the impact of prolonged stays can have on patient outcomes.
Dr. Clement highlighted that waiting times in A&E have escalated since the Covid-19 pandemic, with hip fracture patients experiencing increased lengths of stay and mortality rates when spending over four hours in the emergency department. The six NHS hospitals in Scotland mark 133,454 “unplanned” A&E attendances in August, with 69.4% seen and either admitted, transferred, or discharged within four hours. Meanwhile, in England, 76.3% of A&E patients were seen within four hours in August. An NHS England spokesperson acknowledged the pressure on services, committing to long-term solutions and aiming to enhance A&E care.
Caroline Abrahams, charity director at Age UK, stressed the importance of timely operations for older individuals without financial burdens. The Scottish Government underlines its ongoing efforts to improve A&E performance and patient flow, recognising the adverse effects of extended A&E waits on patient outcomes. The study’s findings shed light on the critical impact of timely care on hip fracture patients and highlight the significance of efficient emergency services in mitigating adverse health outcomes.