People wait in the emergency department to be seen, and often again for a hospital bed. The research says the waiting itself carries risk. Here is how big that problem is.
1 in 82
In England, for every 82 admitted patients kept in the emergency department beyond 6 to 8 hours waiting for a bed, there was one extra death within 30 days.
One admitted patient waiting for a bedOne extra death
For every 82 admitted patients whose time to inpatient bed transfer is delayed beyond 6 to 8 hours from time of arrival at the ED, there is one extra death.
Jones et al., Emergency Medicine Journal, 2022 [1]
In the United States alone, emergency departments handled 155 million visits in 2022. Each one is a person who came in needing help.
155 million
US emergency department visits in 2022.
In 2022, 155 million emergency department (ED) visits occurred in the United States.
Cairns, Ashman and Kang, NCHS Data Brief No. 503, 2024 [2]
At the door, patients are sorted quickly, with only what can be seen and asked.
In a study of 5.3 million adult emergency visits, the standard triage scale correctly flagged about two thirds of patients with high-acuity illness.
About 34 in 100
high-acuity patients were not identified as high-acuity by the standard triage scale.
One high-acuity patientNot identified as high-acuity
The sensitivity of ESI to identify a patient with high-acuity illness (correctly assigning ESI I or II among patients who had a life-stabilizing intervention) was 65.9%.
Sax et al., JAMA Network Open, 2023 [3]
Researchers followed 5.2 million admitted patients in England. After five hours in the emergency department, deaths within 30 days rose steadily with every additional hour, up to twelve.
England's emergency physicians estimate what that meant across 2023.
268 a week
More than 268 excess deaths a week in England in 2023 were associated with waits of 12 hours or longer, almost 14,000 for the year. Each empty seat is one death.
RCEM estimates that there were almost 14,000 associated excess deaths related to waits of 12 hours or longer in 2023
Royal College of Emergency Medicine, 2024 [4]
When waits stretch, some patients walk out before a doctor sees them. In Ontario, Canada, the monthly share leaving unseen topped its earlier high of 4.0% in 15 of the 36 months from April 2020, and outcomes after leaving got worse.
34 in 1,000
adults in Ontario who left an emergency department unseen in April 2022 to March 2023 died or were hospitalized within 7 days. In April 2014 to March 2020 it was 29 in 1,000.
One person who left unseenDied or hospitalized within 7 days
The composite outcome of 7-day all-cause mortality or hospitalization was 3.4% in the recent period versus 2.9% in the baseline period
McNaughton et al., JACEP Open, 2024 [5]
PrIAge is a small team studying this problem first. If you work in an emergency department, run one, or have waited in one, we'd like to hear what you've seen.
Or write to hello@priage.app