2023-11-09 11:01:18
The teams from AP-HP, Inserm, Sorbonne University, coordinated by Professor Yonathan Freund and Dr Mélanie Roussel (UFR santé de Rouen, University of Rouen Normandy) studied the mortality of elderly patients who had undergone a night in the emergency room on a stretcher while waiting for a hospitalization place. For the first time, scientific proof of excess mortality in these patients has been provided. This study, carried out with the methodological help of the URC EST Clinical Research Unit team of Professor Tabassome Simon (AP-HP and Sorbonne University), promoted by the AP-HP, was the subject of a publication in the journal JAMA Internal Medicine on November 6, 2023.
In December 2022, emergency services in France and Europe experienced a considerable increase in the number of patients requiring emergency hospitalization, including a large proportion of fragile and elderly patients. The hospital system might not effectively cope with such pressure due in part to a triple concomitant epidemic: COVID-19, influenza, and respiratory syncytial virus (RSV), a situation aggravated by a reduction in the number of beds available downstream of the hospital’s emergency departments. caused by a shortage of personnel. Thus, an unusually high number of elderly patients had to spend at least one night on a stretcher in the emergency room while waiting for a hospital place.
Several preliminary retrospective studies had suggested that this situation might worsen patient mortality, without this risk being able to be clearly established or quantified in the absence of a prospective study making it possible to formally establish a causal link. In particular, the quantification of the risk in the most fragile patients was lacking.
The study “ No Bed Night »
On an initiative of the Hospital-University Federation IMProving Emergency Care (FHU IMPEC) and with the support of the French Society of Emergency Medicine and Samu – Urgences de France, the study “ No Bed Night » was quickly put in place to assess the impact of this overload of emergency services, and its consequences on elderly patients. The study took place from December 12 to 14, 2022, in 97 emergency departments in France, including a total of 1,598 patients over the age of 75 hospitalized following going to the emergency room. After taking into account comorbidities and the initial severity of patients, this study shows that spending a night in the emergency room is associated with a significantly higher risk of in-hospital death: a night spent on a stretcher in the emergency room increases by almost 40% the risk of hospital mortality, which increases from 11.1% to 15.7%.
To illustrate these figures: if all the patients in this study had been able to be admitted to a hospital room before nightfall, 3% of deaths might have been avoided. This deleterious effect is confirmed on the risk of occurrence of complications during hospitalization (nosocomial infections, falls, bleeding, etc.).
“Among patients with a limited level of autonomy and requiring daily assistance, spending the night on a stretcher in the emergency room increases the risk of mortality by almost two times. »
In conclusion
This large prospective study of national scope, published in the journal JAMA Internal Medicine, shows that a night spent in the emergency room while waiting for a hospitalization place significantly increases the mortality of patients over 75 years old, and in particular that of older people. fragile. Measures must be taken to avoid this excess mortality as much as possible, and the objective of “ zero stretcher beds » in the emergency room, particularly for patients over 75 years old, must be considered a public health objective.
• References: Mélanie Roussel, Dorian Teissandier, Youri Yordanov, Frédéric Balen, Marc Noizet, Karim Tazarourte, Ben Bloom, Pierre Catoire, Laurence Bérard, Marine Cachanado, Tabassome Simon, Said Laribi, Yonathan Freund. JAMA Internal Medicine.
• The Risks of Being in Limbo in the Emergency Department Timothy S. Anderson, MD, MAS; Shoshana J. Herzig, MD, MPH JAMA Internal Medicine
• Interview with Yonathan Freund, MD, PhD, author of Overnight Stay in the Emergency Department and Mortality in Older Patients, and Timothy S. Anderson, MD, MAS, author of The Risks of Being in Limbo in the Emergency Department. Hosted by Louise Aronson, MD, MFA.
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