Prognosis of Geriatric Patients With Non-bedded Night in the Emergency Department: a Multicenter Cohort Study

The activity and number of admissions to emergency departments are constantly increasing, resulting in the overloading of emergency departments, a problem shared by most Western countries, for a variety of reasons. The ageing of the population and the increasing scarcity of outpatient medical services have led to an increase in the number of consultations in emergency departments by patients aged over 75. These demographic changes and the reduction in the number of hospital beds in France have led to overcrowding in emergency departments (EDs), with long waiting times for patients to be admitted to hospital. Emergency department overcrowding is directly associated with an increase in mortality at 24 hours (adjusted OR 1.42; 95%CI 1.08-1.88) and at 72 hours (adjusted OR 1.27; 95%CI 1.02-1.58) after a visit to the emergency department. Similarly, several retrospective studies report an association between in-hospital mortality and the time spent in the emergency department, and the time spent waiting for a hospital bed in particular.

The No Bed Challenge, organised by Samu Urgences de France (SUDF) in 2018, identified patients who spent the night on a stretcher waiting for a hospital bed. Beyond the long waiting time and its association with excess mortality, spending the night on a stretcher can be associated with a worsening prognosis: the conditions of care and comfort are degraded, and the risks inherent in such a nightly wait on a stretcher are multiple. It has been described that beyond 5 hours, waiting is linked with a linear increase in 30-day mortality. In addition, several retrospective studies report a longer waiting time for a downstream hospitalization bed for the geriatric patient population. This longer waiting time is also associated with the occurrence of adverse events, increasing by 3% for each hour spent in the emergency department. However, the characteristics of patients spending the night in the emergency department while waiting for a hospital bed, and their prognosis, are not known - particularly in France.

The objective of the NoBedNight study is to study the in-hospital mortality of patients over 75 years old who spent the night on a stretcher. It will also allow us to describe the typology of these patients, and to compare them to a similar population who had access to an outpatient bed after a visit to the emergency room.

The study aim to evaluate the in-hospital mortality of patients over 75 years old spending the night on a stretcher in the emergency room while waiting for an inpatient bed by collecting data collected in the course of care.

This national retrospective multicentre cohort study will provide information on the clinical characteristics of this population, their frailty index (assessed by Charlson's Comorbidity Index) and their level of dependence (GIR scale) which will be calculated a posteriori on the data collected during care, as well as their clinical presentation, their reason for referral and the occurrence of complications during hospitalisation.

It will make it possible to evaluate the number of geriatric patients waiting for a hospital bed over a short-predefined period in our French emergency services.

The increase in the overload of emergency departments leads to regular national crises in France and in Western countries. It is important to assess the consequences on the health of patients, particularly geriatric patients.

According to the literature, the hypothesis is that mortality is increased in geriatric patients who spend a night on a stretcher in an emergency department because they do not have an inpatient bed.

In recent years, many ideas have been put forward to alleviate the overloading of emergency departments, the cause of which is multifactorial. However, obtaining precise and updated data will make it possible to evaluate the magnitude of the risks inherent in waiting for an outpatient hospital bed for elderly patients and to conclude on the mortality of patients at 30 days.