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Department of Emergency Medicine, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran; Associate Professor of Emergency Medicine.
Abstract: (16 Views)
Abstract
Introduction: Prolonged length of stay (LOS) in the emergency department (ED) is one of the major operational challenges faced by healthcare systems worldwide. Extended ED stays contribute to delays in diagnosis and treatment, increased patient morbidity, inefficient utilization of resources, reduced quality of care, and substantial financial burdens on hospitals. Identifying the determinants of prolonged LOS is essential for optimizing patient flow and improving the efficiency of emergency services. Given the limited evidence from Urmia, this study aimed to determine the characteristics and contributing factors associated with prolonged LOS in the ED of Imam Khomeini Hospital (RA) in 2023.
Materials and Methods: This cross-sectional study was conducted throughout 2023 in the ED of Imam Khomeini Hospital (RA), Urmia, Iran. A LOS exceeding 6 h was defined as a prolonged stay. Data were obtained from patient medical records and documented using a structured researcher designed checklist. Variables included demographic characteristics, triage level, time of presentation, prehospital emergency report, initial diagnostic procedures, specialist consultation, and final ED disposition. The data were analyzed using Chi square test, independent t-test, one way analysis of variance (ANOVA), and the Kruskal–Wallis test in SPSS software (version 18).
Results: Among 21,301 ED visits in 2023, 203 patients with LOS (>6 h) were included in the analysis. The mean age of patients was 47.3 years, and 59.6% were male. The highest proportion of patients was observed in the 41–60 year age group (P=0.013). Most patients were classified as triage level 2 (80.3%), which showed a significant association with prolonged stay (P=0.001). Prolonged stays were more frequent during the night shift (42.9%; P=0.008), while the distribution across days of the week was not statistically significant (P=0.080). Diagnostic or laboratory procedures were performed for 93.1% of patients and specialist consultations for 16.2% (P=0.001). Ultimately, 50.2% of patients were admitted, while 30% were discharged from the ED, with no significant association between disposition and prolonged stay (P=0.492).
Conclusion: Prolonged LOS in the ED was associated with nighttime workload, higher triage acuity, and the need for extensive diagnostic and management processes. Enhancing access to specialist consultation, strengthening diagnostic resources, and improving patient flow systems may contribute to reducing prolonged ED stays and improving the overall quality and efficiency of emergency care.
Key words: Emergency Service, Hospital, Length of Stay, Patient Admission, Triage
Introduction: Prolonged length of stay (LOS) in the emergency department (ED) is one of the major operational challenges faced by healthcare systems worldwide. Extended ED stays contribute to delays in diagnosis and treatment, increased patient morbidity, inefficient utilization of resources, reduced quality of care, and substantial financial burdens on hospitals. Identifying the determinants of prolonged LOS is essential for optimizing patient flow and improving the efficiency of emergency services. Given the limited evidence from Urmia, this study aimed to determine the characteristics and contributing factors associated with prolonged LOS in the ED of Imam Khomeini Hospital (RA) in 2023.
Materials and Methods: This cross-sectional study was conducted throughout 2023 in the ED of Imam Khomeini Hospital (RA), Urmia, Iran. A LOS exceeding 6 h was defined as a prolonged stay. Data were obtained from patient medical records and documented using a structured researcher designed checklist. Variables included demographic characteristics, triage level, time of presentation, prehospital emergency report, initial diagnostic procedures, specialist consultation, and final ED disposition. The data were analyzed using Chi square test, independent t-test, one way analysis of variance (ANOVA), and the Kruskal–Wallis test in SPSS software (version 18).
Results: Among 21,301 ED visits in 2023, 203 patients with LOS (>6 h) were included in the analysis. The mean age of patients was 47.3 years, and 59.6% were male. The highest proportion of patients was observed in the 41–60 year age group (P=0.013). Most patients were classified as triage level 2 (80.3%), which showed a significant association with prolonged stay (P=0.001). Prolonged stays were more frequent during the night shift (42.9%; P=0.008), while the distribution across days of the week was not statistically significant (P=0.080). Diagnostic or laboratory procedures were performed for 93.1% of patients and specialist consultations for 16.2% (P=0.001). Ultimately, 50.2% of patients were admitted, while 30% were discharged from the ED, with no significant association between disposition and prolonged stay (P=0.492).
Conclusion: Prolonged LOS in the ED was associated with nighttime workload, higher triage acuity, and the need for extensive diagnostic and management processes. Enhancing access to specialist consultation, strengthening diagnostic resources, and improving patient flow systems may contribute to reducing prolonged ED stays and improving the overall quality and efficiency of emergency care.
Key words: Emergency Service, Hospital, Length of Stay, Patient Admission, Triage
Type of Study: Research |
Subject:
General
Received: 2026/02/14 | Accepted: 2026/06/22 | ePublished ahead of print: 2026/07/13
Received: 2026/02/14 | Accepted: 2026/06/22 | ePublished ahead of print: 2026/07/13
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