A new study by the University of Warwick working with the Society for Acute Medicine has found that younger patients with simpler problems are waiting less time for assessments than frail patients with complex care needs.

The study has found this is due to the NHS England policy of same day emergency care (SDEC). SDEC involves attempting to discharge as many patients with acute medical problems as possible on the same day without being admitted to a ward and is a major policy of NHS England.

This means care targets are being missed for older and frail patients. The study also found that the worst time to need medical assessment in hospital was 4-8 pm when the time targets were least likely to be met.

The study showed that:

  • Frail patients are waiting longer for emergency care than fitter ones, with the frailer a patient was, the more likely they were to have to wait longer for care.
  • Patients with ‘geriatric syndromes’ – a term for conditions mainly seen in frail older adults where illness can cause problems such as confusion or reduced mobility and falls – were less likely to be assessed within 4 hours than patients without these syndromes.
  • The study found no other reason besides age to explain these findings, with no risk measures – such as blood pressure or temperature – suggesting patients without geriatric syndromes needing seeing more urgently. 
  • Across the day, less than 35% of patients with a geriatric syndrome were seen within the four-hour target.

Professor Daniel Lasserson (pic), lead researcher and Professor of Acute Ambulatory Care at The University of Warwick, commented: “The data from this study shows a concerning trend across the NHS. Hospitals may not be giving equal priority to our frail and older patients and are favouring younger patients with simpler needs who can be assessed and treated more quickly.

“We conclude that this is a result of the NHS England drive for SDEC which prioritises patient flow through SDEC units, involving quicker care for younger patients. This results in slower care for our older, more frail patients who will inevitably require longer, more complex assessments.

A total of 152 hospitals provided patient level data relating to 7248 emergency medical admissions. The Clinical Frailty Scale (CFS) was used to assess patients’ levels of frailty.