“Leaving our patients to spend the night on a stretcher, we already understood the indignity of the thing, notes Dr. Catherine Legall, head of emergencies at Argenteuil hospital (Val-d’Oise); we can now say, with supporting figures, that it is deadly! “. Like many of her colleagues, the emergency physician was not surprised by the results of the study published on November 6 by teams from Assistance publique – Hôpitaux de Paris (AP-HP), the Inserm and Sorbonne University in the review JAMA Internal Medicine. Even less surprised that ” his “ emergencies took part in the survey, with 96 other services throughout France.
Dr. Legall nonetheless emphasizes the “ importance » figures announced: the risk of dying in hospital, for a patient over 75 years old admitted to the emergency room and who spends an entire night waiting for a bed in another department, increases from 11.1% to 15.7% . An increase of almost 40%, according to this study called “No bed Night”, carried out from December 12 to 14, 2022, while a “triple epidemic” (Covid, flu and respiratory viruses) was surging, and including 1,598 patients aged over 75.
For the group of patients who are already dependent, with little or no autonomy, a night spent waiting for a hospital bed practically doubles the risk of dying, we learn. The study also shows a higher risk of complications – falls, nosocomial infections, pressure sores, etc.
“Prolonged discomfort, lack of meals”
“We started from the observation, recurring in our services, that patients wait too long in the emergency room, and the equally recurring warnings that each winter is more difficult than the previous one, to launch this in-depth statistical investigation, based on a cohort taking into account the comorbidities, age and initial seriousness of the patients, explains Professor Yonathan Freund (AP-HP) who, with Doctor Mélanie Roussel (University of Rouen Normandy), coordinated the work. These were things suggested, anticipated, for which we have now demonstrated that there is a real association. argues this doctor from Pitié-Salpêtrière (Paris).
Among the factors that could explain this excess mortality, he cites “the fact of not sleeping, of not having sufficient supervision, because the emergency rooms are overloaded, or of not always having treatment on time, prolonged discomfort, lack of meals…”.
Of the “preliminary retrospective studies” had suggested this increased risk of mortality in elderly patients, recalled the AP-HP in a press release. “For the first time, scientific proof has been provided,” she also writes, calling for the objective of “zero stretcher beds” in emergencies, particularly for the elderly, is considered a “public health objective”. The head of state, Emmanuel Macron, committed, in April, to “unclog” emergencies by the end of 2024.
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