New data reveals link between A&E waiting times and chance of death

Your risk of dying within 30 days more than doubles if your attendance at A&E lasts more than 12 hours, compared with those that are finished in two hours.

That's even after adjusting for factors related to the general health and age of the patients, their condition upon arrival at A&E and the type of complaint they were coming to A&E for, according to a new study published by the Office for National Statistics (ONS).

Patients who spent three hours in A&E were 10% more likely to die in 30 days, compared with those who waited two hours. The chance of death was 60% higher for those who spent six hours in A&E, 90% higher at nine hours, and 110% higher at 12 hours.

The study, carried out by the ONS in collaboration with NHS England, the Department for Health and Social Care and the Royal College of Emergency Medicine (RCEM), examined the health outcomes of all 6.6m people who attended A&E in England between March 2021 and April 2022, excluding those who died in A&E.

A total of 88,000 of those patients (1.3%) died within 30 days of either being released to go home or admitted to another part of the hospital.

Of patients who spent a total of 12 hours at A&E, more than 5% died within 30 days, compared with less than 0.3% of patients who waited two hours, a difference of 19.4 times.

Many of those patients whose A&E attendances lasted longer will have come in with more serious conditions, or in worse overall health, explaining why the risk caused by longer waits at A&E is deemed by the study to be lower than the raw difference between the percentage of people who died.

How are A&E waiting times at the moment?

Long waits at A&E have got significantly worse since COVID. The most recent figures for December showed a total of 677,473 patients in England had to wait longer than four hours to be seen - equivalent to 29%, almost six times higher than the 5% target.

That compares with 396,198 patients who waited more than four hours in December 2019, and just 89,917 in December 2010.

The number of "trolley waits" - patients continuing to wait in A&E after a decision has been made by a clinician that they need to be admitted to another part of the hospital - have also rocketed.

Waits over 12 hours were almost non-existent before COVID, but there were 54,207 in December alone.

That figure, recorded in just one month, is higher than the total recorded over the 134 months put together from August 2010 to September 2021.

Given the study period for the analysis came at the end of the COVID pandemic, the authors say that they may not be exactly representative of the situation today.

That's because of both the higher risk of mortality within 30 days due to the effect of the pandemic itself, and the fact that A&Es may have been operating in a different way to normal, to avoid cross-contamination between patients for example.

Dr Tim Cooksley, immediate past president of the Society for Acute Medicine, told Sky News the number will be rising, compared to when the study was carried out - not falling:

"Those waiting for 12 hours in emergency departments are increasing. The overcrowding and impacts of this will invariably have resulted in a greater number of avoidable deaths in the last 12 months.

"This important data from the ONS further illustrates the importance of timely acute care and the harm caused from prolonged waits - succinctly and sadly the early death of many people. This is a personal tragedy for too many families."

The authors of the study pointed out A&E attendances had largely returned to normal by June 2021, a few months into the period, so the impact of COVID on the results of the analysis shouldn't be overstated.

Although they cannot definitively make a link between longer waits at A&E and causes of post-discharge death, the statistical differences are significant, even after adjusting for more serious illnesses and patients with worse general health etc.

The RCEM described the study as "defining" and "comprehensive", adding it "must be a catalyst for political action".

Dr Adrian Boyle, the president of the RCEM, said "this is a seminal piece of work by the ONS... which validates and reinforces what we know; long waits in the ED are extremely dangerous and a significant threat to patient safety.

"Hundreds of deaths each week are associated with long waits in A&E - each one someone's loved one - mums, dads, sisters, brothers, grandparents.

"There must be a point where we go beyond analysis and accept that this is a serious problem that needs urgent political action. This data is too compelling to ignore and must be the catalyst for change."

Commenting on behalf of NHS England, Professor Julian Redhead, NHS national clinical director for urgent and emergency care, said: "We know there is a real impact when patients wait too long in A&E.

"This is a result of pressure across health and social care, including record A&E and GP attendances, challenges discharging patients from hospital, and wards routinely operating at close to 100% capacity...

"More needs to be done to support patients and hard-working NHS staff, and we will work with government to develop further plans to improve urgent and emergency care, including shifting more care to community settings."

The Data and Forensics team is a multi-skilled unit dedicated to providing transparent journalism from Sky News. We gather, analyse and visualise data to tell data-driven stories. We combine traditional reporting skills with advanced analysis of satellite images, social media and other open source information. Through multimedia storytelling we aim to better explain the world while also showing how our journalism is done.

(c) Sky News 2025: New data reveals link between A&E waiting times and chance of death