Overnight Stays in ER Raise Older Patients' Risk of Death

3 min read

Nov. 15, 2023 – Older people who wait overnight in the emergency department due to hospital bed shortages are more likely to die or have new health problems during their stays, according to a large new study.

The findings from French researchers were published this month in the journal JAMA Internal Medicine. The analysis included 1,598 people ages 75 years and older who went to emergency departments and stayed there overnight while waiting for admission to a hospital. The average age of people in the study was 86. The researchers compared outcomes for two groups: those who stayed in the emergency department from midnight to 8 a.m., and those who were admitted to the hospital before midnight.

Co-author Yonathan Freund, MD, PhD, called the study period during December 2022 a “peculiar time” because Europe, like the United States, was going through a tripledemic of flu, COVID-19, and respiratory syncytial virus (RSV), according to a podcast interview released along with the study results.

“We had a huge surge of older patients who needed hospital beds, and of course there were not enough,” said Freund, who is a practicing doctor in Paris and a professor at France’s Sorbonne University.

The analysis showed that people who stayed overnight in the emergency department died during their hospital stay at a rate that was 40% higher than that of people who were admitted to a room before midnight. The death rate among people who stayed overnight in the ER was 15.7%, compared to 11.1% for people who got a room before midnight.

The increased rate of death during hospital stays after being in the emergency room overnight was particularly higher among people who were not fully independent, meaning they needed help with daily living activities.

People who spent the night in the ER also had a higher rate of other health problems during their hospital stays, compared to people who were admitted before midnight. Overnight ER stays were linked to a 24% increased risk of new health problems. New problems that the researchers looked for included falls, infections, bleeding, heart attacks, strokes, pressure ulcers, and blood clots.

People who didn’t get an overnight hospital room and stayed in the ER instead were also more likely to have longer hospital stays, compared to those who were admitted before the clock struck 12.

Before the COVID-19 pandemic, 90% of emergency departments in the U.S. regularly reported overcrowding, and wait times averaged more than 2.5 hours in 2022, according to a commentary published alongside the study. 

The new findings point to several options for emergency departments and hospitals to make improvements, wrote commentary authors Timothy S. Anderson, MD, MAS, of the University of Pittsburgh, and Shoshana J. Herzig, MD, MPH, of Harvard Medical School. 

They suggested creating new sections in ERs that are less stressful and addressing staffing to monitor people waiting in ERs who are considered stable but just awaiting hospital admission. A third area to consider is staffing changes in hospitals that could improve the flow of discharging people, which could reduce bed shortages. Another option that could change the “outflow” of patients is the use of “discharge lounges” to free up rooms, they said.