Emergency Department Length of Stay, Employment Status, and Subsequent Risk of Hospitalisation: A survival analysis of linked administrative records in England
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Objectives To investigate the association between time spent in NHS Type 1 emergency departments (EDs, consultant led 24-hour services with full resuscitation facilities) and risk of leaving employment and hospitalisation after leaving the department alive up to two years after attendance. Methods We conducted a retrospective cohort study using linked administrative data from the NHS Emergency Care Dataset, Hospital Episode Statistics, Census 2021, and mortality records. ED length of stay was categorised from under 2 hours to 12 hours or more. Cox proportional hazards models were fitted to estimate the association between ED length of stay and subsequently leaving employment or being hospitalised over a two-year follow-up period, adjusting for demographic, socioeconomic, and clinical characteristics. Results Our study population comprised 3,347,008 individuals aged 25–64 who attended a Type 1 ED in England between April 2021 and March 2023. For leaving employment, adjusted hazard ratios (aHRs) increased from 1.04 (95% CI 1.03–1.06) for stays of 2 to <4 hours to 1.21 (1.17–1.24) for 12 hours or more, compared with stays under 2 hours. A similar but more pronounced gradient was observed for post-discharge hospitalisation, with aHRs rising from 1.06 (1.04–1.07) at 2 to <4 hours to 1.95 (1.91–1.99) for stays of 12 hours or more. Conclusions Prolonged time spent in the ED is associated with poorer outcomes among working-age employees, including reduced labour market participation and increased hospital use. These findings suggest that long ED stays may have wider and longer-term implications beyond immediate clinical outcomes, including potentially for national labour markets and economic growth.
Source: medRxiv
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7220932646