Older and frail patients waiting longer for emergency care than younger patients – SAMBA data

A study led by the University of Warwick in collaboration with the Society for Acute Medicine has found that younger patients with simpler problems are waiting less time for assessments than older and frailer patients with complex care needs.

The study, which utilised data collected in the annual Society for Acute Medicine Benchmarking Audit (SAMBA), suggests this is largely due to the national drive to prioritise same day emergency care (SDEC).

SDEC involves providing urgent care in hospital without the need for admission to a ward which can lead to the prioritisation of patients with simpler needs who can be treated and discharged more quickly.

The study, published in the journal eClinicalMedicine, also found that the worst time to require a medical assessment in hospital was between 4pm and 8pm when longer delays are likely to occur.

The study also showed:

  • Patients with ‘geriatric syndromes’ – a term for conditions mainly seen in frail older adults where illness can cause problems such as confusion or reduced mobility and falls – were less likely to be assessed within four hours than patients without these syndromes. 
  • No other reason was found besides age to explain these findings, with no risk measures – such as blood pressure or temperature – suggesting patients without geriatric syndromes need to be seen more urgently.
  • Across the day, less than 35% of patients with a geriatric syndrome were seen within the target of four hours. 

Professor Lasserson, lead researcher and professor of acute ambulatory care at the University of Warwick, commented: “The data from this study shows a concerning trend across the NHS. 

“Hospitals may not be giving equal priority to our frail and older patients and are favouring younger patients with simpler needs who can be assessed and treated more quickly.

“We conclude that this is a result of the NHS England drive for SDEC which prioritises patient flow through SDEC units, involving quicker care for younger patients. 

“This results in slower care for our older, more frail patients who will inevitably require longer, more complex assessments.”

A total of 152 hospitals provided data relating to 7,248 emergency medical admissions as part of a snapshot audit by SAM on 23 June 2022.

On this day, 76.4% of patients were assessed within four hours of arriving at hospital.

Dr Tim Cooksley, immediate past president of the Society for Acute Medicine, said: “This important study is a further illustration of the tremendous strain that the urgent and emergency care (UEC) is under.

“We know that older patients are more likely to experience degrading corridor care and this data illustrates that with further delays to important components of their care. This increases the likelihood of adverse outcomes.

“We desperately need increased capacity and workforce in the UEC system. We need to ensure timely transfer of patients to acute medical units and acute frailty units so these patients can receive the high quality care they deserve and that our teams wish to deliver.

“Importantly, this requires urgent support for the large numbers of older patients who wish to be at home but whose discharge is delayed due to lack of workforce in the social care system or timely access to high quality rehabilitation facilities.

“We are heading for more extremely troubled times in the NHS. We are all desperately concerned that the winter months are likely to be similar to the appalling scenes witnessed last year. Older people are particularly vulnerable.

“Clinical staff and patients remain energised to avert this: governments must follow suit.”