Factors affecting prolonged Emergency Department stays in the over 75s

Abstract

The effects of emergency department (ED) crowding on patient morbidity and mortality are well described, with older adults particularly vulnerable to harm. Accordingly, the Health Service Executive specifies that ≤1% of patients aged ≥75 years should have an ED length of stay (LOS) of ≥24 hours. Nevertheless, 18,497 older adults spent over 24hrs in Irish emergency departments in 2024 (7.7% of total national ED attendances by this age group). Possible reasons for excessive ED LOS have not been explored in an Irish context.

We audited all adults aged ≥75 who presented to the ED at St. Vincent’s University Hospital in January and February 2025 who had total ED LOS ≥24 hours. Demographic information, ED total LOS (measured from registration to departure) and the presence of factors contributing to total LOS were extracted from the ED electronic assessment records. These factors were: need for advanced imaging (CT-Brain, any other CT, and/or MRI), presence of delirium or dementia as a marker of high care needs, and any active respiratory or drug-resistant-organism infection control issue delaying ward bed allocation. Descriptive statistics are presented as numbers (percentage of totals) and means ±standard deviations. Lengths of stay are presented as medians (interquartile ranges) with a Kruskal-Wallis test and Dunn-Bonferroni correction for significance for each factor grouping. Alpha was set at <0.05...