Evening admissions could mean you are in hospital for four days longer than if you’d been admitted in the morning
New research has revealed that whether you go to A&E in the morning or evening can drastically effect the amount of time you spend waiting to be seen, as well as how long you stay in hospital; with crowding also being linked to mortality.
Director of clinical development at the North West Utilisation Management Unit, Seamus McGirr and his team investigated data from 18 British hospitals to try and capture the admission trends populating A&E departments, in an attempt to pinpoint how the process can be streamlined and made more effective.
Interestingly, the findings reveal that the delay to be seen by the relevant doctor you can expect in a thriving A&E will approximately double every hour from 9.00am onwards, with the average patient needing to arrive by 1.00pm at the latest to ensure they receive services before 5.00pm, when activity on the wards begins to wind down. If you are admitted during the evening, you could end up being in hospital for four whole days more than if you have arrived during the course of the morning. However, the majority of ambulance arrivals, whether by a direct 999 call or as requested by a GP, will turn up at the hospital after 1.00pm. With less attending staff, yet more patients, it’s no surprise that A&E in the afternoon and evening is annoyingly congested.
Generation gap
Older people are often over-represented in A&E, with 14.5% of all attendances and 26.8% of all admissions dealing with patients over the age of 75. Also, 35% of waits that are over six hours long are by patients who are over 75 years old, and they normally have longer to hang around on trolleys than younger people as well. OAP’s are also more likely to be late evening admissions.
Oddly, A&E admission numbers are actually higher from Monday to Fridays compared to the weekends, however no matter what day you end up in A&E, the later you arrive, the longer you will stay in hospital, according to researchers. On the other hand, GP referred admissions during typical working hours have a shorter than average length of stay but out of hours GP referrals end up being significantly longer than the norm.
Whether you walk in off the street or are referred by your GP will also have an impact on your length of stay, as the experts discovered that patients admitted between 8.00am and 6.00pm have a stay that is two days shorter that A&E referrals. Overnight GP admissions between 12.00am and 7.00am however will have a significantly longer stay than A&E referred admissions, equaling between three to five days more.
Rising ranks
The rank of your doctor will also affect your length of wait and duration in hospital. The more senior a doctor is, the less diagnostic tests they will order, which means less time hanging around. More junior doctors tend to order more tests and scans which means you’ll have to stay for longer and you will also cost the NHS more money.
38% of non-elective ward arrivals take place between 5.00pm and midnight, which frustratingly is when many diagnostic support services are being reduced, and clinical teams are dwindling down for the smaller evening cover. This reduction in available services and senior doctors end up having a direct correlation to how quickly patients can be turned around, and can even add days on to the length of stay.
McGirr and his team comment that increasing access to wards and community services during the day could reduce the healthcare expenditure as well as improve patient outcomes. They also place an emphasis on quick and concise decision making, which is usually seen by senior member of staff, playing a key part in getting patients on the mend and out of hospital quickly.
What are your experiences of A&E? Do you feel this analysis is true?
