Emergency Department Length of Stay, Employment Status, and Subsequent Risk of Hospitalisation: A survival analysis of linked administrative records in England
- 1Office for National Statistics
Abstract
ObjectivesTo 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.
MethodsWe 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.
ResultsOur 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.
ConclusionsProlonged 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.
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BibTeX
@misc{aston2026emergency,
title = {{Emergency Department Length of Stay, Employment Status, and Subsequent Risk of Hospitalisation: A survival analysis of linked administrative records in England}},
author = {H. Aston and V. Nafilyan and A. Boyle and D. Ayoubkhani},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.05.26364765},
url = {https://www.medrxiv.org/content/10.64898/2026.10.05.26364765v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Emergency Department Length of Stay, Employment Status, and Subsequent Risk of Hospitalisation: A survival analysis of linked administrative records in England
AU - H. Aston
AU - V. Nafilyan
AU - A. Boyle
AU - D. Ayoubkhani
PY - 2026
DA - 2026/10/05
PB - medRxiv
DO - 10.64898/2026.10.05.26364765
UR - https://www.medrxiv.org/content/10.64898/2026.10.05.26364765v1
AB - ObjectivesTo 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. MethodsWe 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. ResultsOur 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. ConclusionsProlonged 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.
ER -