Older patients ‘bear brunt’ of A&E overcrowding crisis

Older patients are bearing the brunt of the overcrowding crisis in emergency departments, a new study indicates.

Patients aged 80 and over wait more than twice as long for admission to a hospital bed as those aged under 20, according to research published in the Irish Medical Journal.

“Hospital wards cherry-pick the younger patient who is likely to have a shorter hospital stay, with the result that the elderly wait longer in the emergency department. This means that not only is the emergency department crowded but it is crowded with elderly patients with complex care needs and significant morbidity” – or sickness – “which creates a huge additional workload for the emergency medical nursing staff,” the authors said.

The analysis is based on a 10-year study of records at the emergency department of Beaumont Hospital in Dublin, but many of the findings have national relevance.

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Year-round pressure

Contrary to popular perception, often fuelled by media headlines, emergency departments are busy year round, with little or no reprieve during summer months, the study says.

It noted that misconceptions about these trends – that overcrowding wasn’t just a winter phenomenon – “can lead to poor decision making” by politicians and local mangers and “consequently result in inefficient use of budgets and resources”.

“Consequently, well-intentioned changes may not deliver expected results. For instance, it has been shown that adding extra beds in the ED can actually make problems worse, depending on circumstances.”

And although the waiting time for a bed is significantly higher in winter, because of a surge in older patients, it takes longer to see a doctor in summer, because more patients are attending.

“Patient experience time”

The average “patient experience time” for patients requiring admission in Beaumont rose from less than 10 hours for patients aged under 20 to 24 hours for those aged 90 and over.

The researchers say the introduction of clinics for minor injuries, such as VHI Swiftcare, has done little to improve the overcrowding crisis, as this is driven by patients who have been admitted being “boarded” in the emergency department while waiting for a bed.

The level of emergency-department overcrowding, they found, is driven by the way older patients are cared for in other areas of the hospital and the wider healthcare system.

Elderly patients with complex care needs are harder to find ward beds for because wards are concerned about beds being occupied by patients with complex discharge-planning needs.