The Dangers of Hospital Admission 3

To maintain a coherent narrative, this blog should have gone out on June 27th following “The Dangers of Hospital Admission, Parts 1 and 2”. The opportunity of commenting on the dangers of World Cup Fever interfered with this timing, hence its delayed appearance now.

In fact I thought that I had reached the end of the subject of hospital admission and had planned to move on to pastures new – but since Parts 1 and 2 were published there has been a flurry of new reports on this subject in the media – both medical and lay publications – with some startling accompanying figures.

Corridor Care

Th British Medical Journal started this off by reporting that last year, 493,751 patients spent more that 24 hours in A & E before being admitted, transferred or discharged. Of these 13,386 waited for at least 3 days. This is the notorious corridor care – a very uncomfortable and very inefficient way of diagnosing and treating acutely ill patients. The number of patients spending at least a day in A&E has risen by a third since 2023.

Some of the comments are interesting:

“….this isn’t a problem related to a few trusts, this is something that’s experienced by all trusts, all of the year.”

“24 hours was pretty much unheard of prior to 2020.”

“I’ve heard of patients who say they’d rather die at home than come into hospital and be waiting”

Is this trend dangerous?

The answer is a definite “yes”. Patients are more likely to come to harm or die if they spend a long time in emergency departments. It is known that corridor care patients have worse mortality – for a number of reasons, not least that treatment is likely to be delayed. Other factors adding to the danger and/or loss of dignity include loss of privacy, limited access to food and liquids and difficulties in getting to the loo – or unnecessary requirement to use bedpans. It has been calculated that patients who spend 12 hours or more in A & E have twice the mortality of those waiting two hours or less.

The Royal College of Emergency Medicine has found that nearly 16,000 patients died because of delayed care in 2024, ten times more than in 2015. Their report calculated that for every 72 patients who wait between eight and 12 hours before admission there is one additional death. An A&E nurse is quoted as likening her department to a “war zone” and tells of a patient who died unnoticed on a corridor and was only found after rigor mortis had set in.

Delirium is a particular problem. Delirium is a sudden temporary state of confusion – it may be hard to spot in the unwell and sleepy patient. It affects about 30% of people over 65 in emergency departments and can be a result of the presenting complaint but is aggravated by anxiety, hearing loss, visual impairment, physical disability, fever and cognitive decline, constipation and pain.

One senior doctor commented “Any doctor working in emergency care will have shifts where they have left the hospital to go home for the night and, returning the next morning, see the same patients in waiting rooms or in corridors. …..in some cases these patients are still waiting for a third day. This is undignified and unsafe. There is no excuse for hospital patients in a developed country being treated this way and doctors are ashamed that it has come to this.”

Is anything being done about it?

The government has pledged to end corridor care by the end of this Parliament – if you believe that….

“…the NHS is reforming the urgent and emergency care system and supporting trusts…” Not much detail here. It is heartening the the government has promised a big policy shift of moving care “from hospital to the community” but again little sign of any action to make this happen. So please forgive my scepticism.

You, dear reader, can also take action – keep active and physically fit with regular exercise. This will reduce your risk of frailty and this in turn will reduce the risk of developing the sort of condition which could lead to you ending up in an A & E department. Compared with the non-frail elderly person, the frail elderly have about 2.3 times the risk of attending hospital as an emergency, double the risk of then  being admitted and, if not admitted, three times the risk of being back in A & E within the next month.

Postscript

The grandson of a friend was taken to A & E earlier this month with high fever and gastrointestinal symptoms. After many hours in the emergency department his parents offered to pay for him to be transferred into a private hospital. Their good intentions were defeated by the bureaucracy. Since he was not in an official NHS bed they were forbidden to transfer to alternative care! You couldn’t make it up.

So that really is the last in my current series of comments about the dangers of hospital care/treatment. Next week I will move on to a new subject. I can’t tell you what because I will try to make it topical – perhaps exercise in a warm climate?!