Repository logo

Factors associated with longer wait times, admission and reattendances in older patients attending emergency departments: an analysis of linked healthcare data

Published version

Change log


jats:secjats:titleBackground and objective</jats:title>jats:pCare for older patients in the ED is an increasingly important issue with the ageing society. To better assess the quality of care in this patient group, we assessed predictors for three outcomes related to ED care: being seen and discharged within 4 hours of ED arrival; being admitted from ED to hospital and reattending the ED within 30 days. We also used these outcomes to identify better-performing EDs.</jats:p></jats:sec>jats:secjats:titleMethods</jats:title>jats:pThe CUREd Research Database was used for a retrospective observational study of all 1 039 251 attendances by 368 754 patients aged 75+ years in 18 type 1 EDs in the Yorkshire and the Humber region of England between April 2012 and March 2017. We estimated multilevel logit models, accounting for patients’ characteristics and contact with emergency services prior to ED arrival, time variables and the ED itself.</jats:p></jats:sec>jats:secjats:titleResults</jats:title>jats:pPatients in the oldest category (95+ years vs 75–80 years) were more likely to have a long ED wait (OR=1.13 (95% CI=1.10 to 1.15)), hospital admission (OR=1.26 (95% CI=1.23 to 1.29)) and ED reattendance (OR=1.09 (95% CI=1.06 to 1.12)). Those who had previously attended (3+ vs 0 previous attendances) were more likely to have long wait (OR=1.07 (95% CI=1.06 to 1.08)), hospital admission (OR=1.10 (95% CI=1.09 to 1.12)) and ED attendance (OR=3.13 (95% CI=3.09 to 3.17)). Those who attended out of hours (vs not out of hours) were more likely to have a long ED wait (OR=1.33 (95% CI=1.32 to 1.34)), be admitted to hospital (OR=1.19 (95% CI=1.18 to 1.21)) and have ED reattendance (OR=1.07 (95% CI=1.05 to 1.08)). Those living in less deprived decile (vs most deprived decile) were less likely to have any of these three outcomes: OR=0.93 (95% CI=0.92 to 0.95), 0.92 (95% CI=0.90 to 0.94), 0.86 (95% CI=0.84 to 0.88). These characteristics were not strongly associated with long waits for those who arrived by ambulance. Emergency call handler designation was the strongest predictor of long ED waits and hospital admission: compared with those who did not arrive by ambulance; ORs for these outcomes were 1.18 (95% CI=1.16 to 1.20) and 1.85 (95% CI=1.81 to 1.89) for those designated less urgent; 1.37 (95% CI=1.33 to 1.40) and 2.13 (95% CI=2.07 to 2.18) for urgent attendees; 1.26 (95% CI=1.23 to 1.28) and 2.40 (95% CI=2.36 to 2.45) for emergency attendees; and 1.37 (95% CI=1.28 to 1.45) and 2.42 (95% CI=2.26 to 2.59) for those with life-threatening conditions. We identified two EDs whose patients were less likely to have a long ED, hospital admission or ED reattendance than other EDs in the region.</jats:p></jats:sec>jats:secjats:titleConclusions</jats:title>jats:pAge, previous attendance and attending out of hours were all associated with an increased likelihood of exceeding 4 hours in the ED, hospital admission and reattendance among patients over 75 years. These differences were less pronounced among those arriving by ambulance. Emergency call handler designation could be used to identify those at the highest risk of long ED waits, hospital admission and ED reattendance.</jats:p></jats:sec>


Peer reviewed: True

Acknowledgements: This paper was produced using CUREd data. We gratefully acknowledge the contribution of the NHS Trusts in the Yorkshire and the Humber region which provided the original data to the University of Sheffield Connected Health Cities Study. Connected Health Cities is a Northern Health Science Alliance (NHSA)-led programme funded by the Department of Health and Social Care and delivered by a consortium of academic and NHS organisations across the north of England. Graham Martin is based in The Healthcare Improvement Studies Institute (THIS Institute), University of Cambridge. THIS Institute is supported by the Health Foundation, an independent charity committed to bringing about better health and healthcare for people in the UK. CUREd data were provided in anonymised form; this paper has been screened to ensure patient confidentiality is maintained. We would like to thank Jamie Mills, Neil Prockter and the Emergency Care for Frail Older People (ECOP) team for their valuable assistance and comments. We thank the editor and reviewers for their insightful comments on previous versions of the manuscript.


Original research, 1506, emergency department, emergency ambulance systems, emergency care systems, geriatrics

Journal Title

Emergency Medicine Journal

Conference Name

Journal ISSN


Volume Title


Ministerio de Ciencia e Innovación (PID2019-104319RB-I00)
National Institute for Health Research (17/05/96, NIHR200166, NIHR300901)