In recent years, the healthcare community has increasingly recognized the critical importance of timely treatment for patients suffering from hip fractures. A recent study published in the Emergency Medicine Journal sheds light on a concerning trend: longer wait times in emergency departments (ED) are linked to a higher risk of death and extended hospital stays for these vulnerable patients.
The study highlights a troubling statistic: over one-third of hip fracture patients in the UK are waiting longer than the national standard of four hours for treatment. This standard mandates that 76% of emergency department patients should either be discharged or admitted within this timeframe. Unfortunately, the reality is that many patients are left waiting, which could have dire consequences for their health outcomes.
Hip fractures are particularly prevalent among older adults, with estimates suggesting that by the age of 80, approximately one-third of women and 17% of men will experience this type of injury. Alarmingly, these figures are expected to double by 2033, placing even greater pressure on emergency services and healthcare systems. The researchers emphasize that early surgical intervention is crucial, as it is associated with lower mortality rates and fewer complications. However, as emergency department wait times continue to increase, the risk of delayed surgery becomes a pressing concern.
To investigate the impact of prolonged wait times on hip fracture patients, the researchers conducted a retrospective analysis of a local hip fracture database. They focused on patients aged 50 and older who were admitted to a single trauma center in Lothian, Scotland, between January 1, 2019, and June 30, 2022. The study monitored these patients for at least eight months, until February 2023, providing a comprehensive overview of their treatment and outcomes.
The trauma center serves a population of approximately 916,310 people and manages over 1,000 hip fractures annually. The study included 3,611 patients, but after excluding those with incomplete data, 3,266 patients were analyzed. The average age of these patients was 81, with a significant majority (72%) being women. On average, patients spent 3.9 hours in the emergency department before being treated.
Interestingly, the average time from admission to surgery was 27 hours, with the average wait time being 22.5 hours. Patients typically stayed in the hospital for about nine days, and follow-up assessments revealed that over 40% of the patients had died within the follow-up period. This statistic underscores the severity of the issue at hand.
Among the patients studied, 39% waited longer than four hours in the emergency department. Those who experienced longer wait times were more likely to be admitted during the winter months, face higher surgical risks, and have fractures that were more challenging to repair. The data revealed a stark contrast in survival rates: nearly 96% of patients who waited less than four hours were alive at 90 days, compared to approximately 93% of those who waited longer. This translates to one additional death for every 36 patients who experienced extended wait times.
The study also found that the risk of death increased with the length of delay before surgery, reaching around 14% after 24 hours. Several factors were identified as independently associated with a higher risk of death at 90 days, including male sex, older age, winter admissions, higher operative risk, residing in care homes, and longer wait times for surgery.
While the researchers acknowledge the observational nature of the study, which limits the ability to establish causation, the findings are nonetheless alarming. They point out that a wait time of over four hours was associated with increased risks of death at 60 days, 90 days, and at the final follow-up check-up. Specifically, the risks were heightened by 29%, 36%, and 15%, respectively.
Despite the lack of clarity on why longer emergency department waits correlate with poorer outcomes for hip fracture patients, the researchers suggest that direct transfer to the operating theater from the emergency department could potentially improve survival rates. This recommendation highlights the urgent need for healthcare systems to address the challenges posed by increasing wait times and to prioritize timely interventions for this vulnerable population.