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New study shows common injury for older people can be fatal if not checked quickly

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Asian elderly man retired headache after fall down

A Scottish study examined the impact of A&E delays in Lothian (Image: Getty)

Patients who have suffered a hip fracture are more likely to die if they are kept waiting for over four hours in A&E, research suggests.

A study estimated that one extra death occurs within 90 days of injury for every 36 patients who wait longer than the national standard for treatment.

They also tropically spent a day longer in hospital than those seen within four hours.

The analysis looked at more than 3,200 hip fracture patients aged 50 and over who attended a trauma centre in Lothian, Scotland, between January 2019 and the end of June 2022.

Study leader Dr Nicholas Clement, from the Royal Infirmary of Edinburgh and the University of Edinburgh, said emergency department waiting times had increased across the UK since the pandemic.

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Royal London Hospital Accident And Emergency

The national standard says most patients should be seen within four hours (Image: Getty)

He added: “We thought we’d look at our hip fracture patients that are more frail than the standard patients that arrives…and sure enough, their length of stay and mortality is increased if they spent longer than four hours in the emergency department.

“It’s kind of understandable – you spend longer on a trolley, the analgesia might not be quite as good, you might be a bit more dehydrated rather than being on the ward.”

One in three patients in the study waited longer than four hours in A&E.

Participants were followed up for more than 500 days and, during this time, 1,314 patients died.

Those who waited too long were 29 percent more likely to die within two months and 36 percent more likely to die within three months of their attendance, compared with those seen within four hours.

It is estimated that a third of females and 17 percent of males over 80 will suffer a hip fracture, with rates predicted to increase, the authors wrote in the Emergency Medicine Journal.

In light of the findings, the Royal Infirmary of Edinburgh has introduced a new “fast track” service so the majority of patients with hip fracture wait for no more than two hours in the emergency room.

Dr Clement added: “Our patients – those that don’t have another problem like a heart attack or a chest infection and can go straight to the ward – they go to the ward within two hours now.

“The best thing is that they spend as little time in the emergency department as possible, because they need to come into the hospital anyway.

“They’ve got a hip fracture, it’s not like any decision needs to be made, they need to come straight into the hospital to get the hip fracture fixed.”

The four-hour A&E wait standard was introduced in the NHS in England in 2004 and later adopted across the UK nations and some other countries.

Under this standard, most patients arriving at A&E must be admitted or discharged within four hours. It has previously been hailed as a barometer for how the NHS as a whole is performing.

Data from Public Health Scotland show that during August there were 133,454 “unplanned” attendances at A&Es in NHS Scotland.

Of these 69.4 percent were seen and either admitted to hospital, transferred, or discharged, within four hours.

Meanwhile, in England some 76.3 percent of patients in England were seen within four hours in A&Es in August.

Caroline Abrahams, charity director at Age UK, said: “We recognise that NHS budgets are under huge pressure but it is absolutely essential that older people who need operations are able to get them within a reasonable timescale and do not feel that the only way they can get the help they need, is to pay for it.”

An NHS England spokesperson said: “We know there is much more to do to deliver timely care for those who need it and we’re rolling out targeted teams across the country to identify frail patients at the front door of our services to ensure they’re treated in the most appropriate setting, such as acute frailty services.

“The NHS has just come out of the busiest summer on record for A&Es, and there continues to be huge pressure on services, so we are committed to working with the Government on long-term solutions as part of the 10-year health plan, while continuing to do everything possible to improve A&E care.”

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