Emergency departments: Night-time arrivals ‘wait longer but are more likely to be admitted’

The likelihood of patients being admitted to a bed from an emergency department (ED) depends on what time of the day they arrive at and how they come to hospital, a Department of Health report shows.

How long patients have to wait in ED also depends on when they arrive, according to the analysis of hospital performance.

Patients requiring immediate attention – those with the highest acuity (priority) – wait on average one hour longer if they arrive at night than during the day. They are 20 per cent less likely to be admitted when arriving during the day, compared to a night-time arrival, the report says.

Similarly, patients arriving by ambulance are 20-25 per cent more like likely to be admitted, compared to other pathways. “This is likely attributable to the higher acuity of patients arriving by ambulance, and the pre-triaging of presentations via this pathway by paramedics prior to conveyance to hospitals.”

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GPs, especially in out-of-hours services, are not sufficiently effective at triaging patients for treatment in the community versus referral to hospital, the report suggests. Some 73 per cent of referrals to an unscheduled (emergency) care setting do not result in an admission, compared to 77 per cent for patients who self-refer.

The report also points to substantial variation in the triage level (acuity) of patients arriving in each health region, especially low acuity patients. Just 8 per cent of presentations in the midwest were standard or non-urgent, compared to 33 per cent in Dublin southeast. This may be due to the presence of three local injury units in the midwest.

The number of patients attending EDs has risen by 45 per cent in just over a decade – from 1.1 million in 2010 to 1.59 million last year.

The heaviest attenders are children aged up to five, and older people aged 76 and up.

The probability of admission increases with age. Twenty-year-olds, for example, have a 14 per cent of admission, compared to 50 per cent for those aged over 80.

Unsurprisingly, the probability of admission is directly related to the triage score given to a patient on arrival. Less than 10 per cent of patients assessed as standard and non-urgent are admitted, compared to 23 per cent of urgent patients. The report says this has implications for which patients are likely best suited to treatment within community settings rather than in the ED.

There is a strong relationship between wait times and age. For example, median wait times for under-fives are 3.5 hours, compared to nine hours for people over 85. “This is likely driven by the triage scores of patients by age, as people of a younger age are less likely to be admitted than older patients” and are therefore able to leave the ED after initial assessment.

Over 60 per cent of children presented to unscheduled care settings outside children’s hospitals last year. The report says policymakers should consider whether these patients can be treated in alternative settings in the healthcare system.