Long A&E wait after a hip fracture means a patient is a third more likely to die

NHS study reveals the impact of four-hour waits on the elderly after the number of patients waiting that long has sky rocketed over the last decade

Elderly people who face a long wait in A&E after fracturing a hip are a third more likely to die in the next three months.

An NHS study reveals the potentially devastating impact of four hour waits to be admitted on to the hospital ward among those who are already frail. Previous research has suggested frail elderly patients are currently waiting longer on average to be admitted.

The NHS study of 3,266 hip fracture patients, with an average age of 81 years, found those who waited more than four hours had a 36% increased odds of dying within 90 days. The researchers said this was the equivalent of one extra death for every 36 patients who waited longer than four hours.

Lead author Dr Nicholas Clement, of the Royal Infirmary of Edinburgh, which hosted the trial, said: "We thought we'd look at our hip fracture patients that are more frail than the standard patients that arrives, and sure enough, their length of stay and mortality is increased if they spent longer than four hours in the emergency department. It's kind of understandable - you spend longer on a trolley, the analgesia might not be quite as good, you might be a bit more dehydrated.”

The four-hour A&E wait standard was introduced in the NHS in England in 2004 and was later adopted across the UK nations and some other countries. Under this standard, most patients arriving at A&E must be admitted or discharged within four hours. Official data stops at the point a patient is admitted but many wait longer on trolleys before a bed becomes available.

The four-hour standard is considered a barometer for how the NHS as a whole is performing. The NHS constitution states that at least 95% of patients should be admitted, transferred, or discharged within four hours of attending A&E. The Tory government watered down this standard in 2022, reducing it to 76%.

During August 76% of patients in England were seen within four hours in A&Es, while this was 69% in Scotland. It followed a huge increase in A&E waits over the last decade, with 18,000 patients waiting more than four hours in May 2014, rising to 181,000 in May 2024.

A third of women and 17% of men aged over 80 will suffer a hip fracture in their lives. The new trial led by Edinburgh University saw 38.6% of patients wait more than four hours. Participants were followed up for more than 500 days and during this time 1,314 died.

The study, published in the Emergency Medicine Journal, also showed those who had waited more than four hours spent an extra day in hospital as an inpatient on average.

An NHS England spokesperson said: "We know there is much more to do to deliver timely care for those who need it and we're rolling out targeted teams across the country to identify frail patients at the front door of our services to ensure they're treated in the most appropriate setting, such as acute frailty services. The NHS has just come out of the busiest summer on record for A&Es, and there continues to be huge pressure on services."

Caroline Abrahams, director at the charity Age UK, said: "We recognise that NHS budgets are under huge pressure but it is absolutely essential that older people who need operations are able to get them within a reasonable timescale.”

The research team at the Royal Infirmary of Edinburgh has since devised a fast-track system for elderly patients with hip fractures so they wait no more than two hours. Dr Clement added: "Those that don't have another problem like a heart attack or a chest infection and can go straight at the ward. The best thing is that they spend as little time in the emergency department as possible and go to the ward. They've got a hip fracture, it's not like any decision needs to be made, they need to come straight in the hospital to get the hip fracture fixed."