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Comment by simonswords82 | Hacker News Reader

As somebody else in this thread pointed out the numbers don’t stack up. This thread is subjective at best

could you link to that pointing out? which parts don't stack up? the 12+ hour wait times, the hospital occupancy, the discharge rate, the aging population and the slashed spending are all seem to be hard numbers (dare I say facts?) ... what doesn't add up?

If you can wait 12 hours, you didn't have an emergency.

And if you can't wait 12 hours you become excess mortality.

Sometime before the 12 hour period, one must make a choice whether to seek care or not.

the 12 hour wait is once the person enters the doors of the facility. In a hospital, if you walk into the ER, people are observing you closely and expediting people at immediate risk of death. A person who can sit in a chair for 12 hours waiting didn't have an emergency. Instead, they were using the ER for non-urgent care.

If the people triaged into 8-12 hour queues have a 16% higher chance of dying in the next month, that's a pretty obvious indication that many of them are, in fact, in critical condition.

I wouldn't trust a stat like that without digging into the underlying causation. The whole twitter presentation is a nice narrative but I see many places where it could just be outright wrong, or saying misleading things (I work in medical biology and have plenty of familiarity with how hospitals run their ERs).

I agree that this sort of thing needs a study.

Fortunately the previous tweet linked to the original source, a published study of 5 million ER visits which appears to have a full set of controls and specifically measures time to inpatient transfer in excess of 5 hours as a mortality risk factor https://emj.bmj.com/content/emermed/39/3/168.full.pdf

A retrospective, observational (IE, after the fact data analysis from a population without controls) study found a risk factor (association). That's not enough to make any real conclusions as to whether this is causal.

It may not be conclusive on the subject of whether the 16% additional deaths were specifically influenced by the additional wait, but in light of that data point, you're going to need a whole lot more evidence to justify your original claim that the cohort that dies 16% more than the baseline population in the days that follow were, without exception, not in any urgent need of medical care...

All I said was: if you can wait 12 hours, it's not an emergency. The emergency room is for things where a person couldn't wait 1 hour without dying. People dying 30 days later: not an ER problem.

Nope, the emergency department of an NHS hospital is absolutely not reserved for things where people couldn't wait one hour without dying (or people who are in danger of death period).

And since we're talking specifically about the subset of NHS emergency department attendees who are more likely to be dead within 30 days if it takes longer than the NHS' target of four hours for them to receive an inpatient bed, I'm pretty unconvinced that the alternative route of booking a doctor's appointment in the next few days to see if he'll refer in a week or two is the more appropriate one...

I know NHS works differently from the US, but the health care providers in the US that are used by major corps (IE, benefits) all have urgent care lines. I've done this repeatedly (to avoid my wife going to the ER with a sick kid). Typically, while it takes a month to get a routine appointment, the kid's doctor always can see them the next day for something urgent.

If you think about it, this makes a lot of sense because ERs are tuned for low latency, low throughput, high cost for emergencies, and if lots of people who just need urgent care go, they make it hard for the emergencies to be seen with low latency.

A few years ago I had an infected gallbladder. It was enormously painful, and I went to ER. It might not have been potentially fatal (I'm honestly not sure if you can die from it), but I didn't know that. I just knew I was in a ridiculously amount of pain.

Anyway, so I went to the ER and to begin I did sit in a chair like you said, however I don't think anyone was keeping an eye on the patients, since by the time someone came to look at me, I had been writhing in pain on the floor for an hour or so, and it had taken another patient to call a nurse over.

All and all it took 4 hours before I got to see a doctor, but this was pre-pandemic.

Still, I think you're probably right and people do show up to A and E for non-urgent issues, however it's probably also tied to how difficult it is to see a GP these days.

Your last sentence is really my underlying point: people use the ER for non-urgent issues because it's available. Ideally, we'd have far more non-ER urgent care (which costs much less to staff and run than an ER) and that would be most people's place to go when their normal doctor couldn't see them.

For the gallbladder, if it's just an infection, not fatal. If it's a gallbladder attack, it can lead to rupture. Definitely needs emergency surgery.

What is the situation of urgent care establishments in the UK? Places you can go for non life threatening but life stopping events, like say a broken leg?

It all goes through A&E, which unfortunately is meant for both the life threatening situations and urgent but not leathal ones yet. You have to go in, register and sit and wait - if it is "just" a broken leg yes you might wait a few hours before being seen.

There's a trend in the US to have urgent care facilities. For example, in my system if I have a problem I call (24/7) and they route me either to urgent care or the ER.

During my visit to urgent care (so early in the days of COVID that there was sign saying only people who had just flew in from Wuhan could be tested), I was seen immediately, the doctor stopped while seeing me, said "the person in the next room is having a heart attack and I have to send him to the ER immediately- I'll be back".

> Instead, they were using the ER for non-urgent care.

FWIW, this isn't always a call that person makes - I've had multiple family members advised to attend by the non-emergency service (111) and ended up with a 6-8 hour wait.

You also can face lengthy waits for something that needs treatment soon but isn't immediately life-threatening (grandfather fell and hit his head on a table, requiring stitches - ~4 hour wait for a handover from the ambulance, another 2-3 before he received an MRI and stitches).

A few years back the doctor sent me over to the ER. Had I gone home instead there would have been zero (above background average) risk of dying in the next 12 hours. That doesn't say the doc was wrong in sending me there--I had a kidney stone, the risk was kidney damage and infection, not dropping dead.

> A person who can sit in a chair for 12 hours waiting didn't have an emergency. Instead, they were using the ER for non-urgent care.

Or the ER was crap. Like the time I waited 12 hours (because I had no choice, I needed a surgeon) to have my foot put back together.

I had a similar situation (sitting in the ER absolutely needing immediate surgery at risk of death), but after a bit I called my parents, who called the surgeon, who saw me immediately (outside the hospital) and then immediately scheduled me for surgery back at the same hospital, all before I would even have been seen at an ER.

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