Factors associated with emergency department length of stay in psychiatric emergencies: a four-year operational analysis of a regional psychiatric emergency medical center in Korea

Psychiatric emergencies impose substantial clinical, operational, and public health burdens, underscoring the need for integrated psychiatric and medical crisis care. In response, the Seoul-type Psychiatric Emergency Medical Center (Seoul-PEMC) was established at Boramae Medical Center in October 2019 as Korea’s first regional PEMC. This study aimed to characterize emergency department length of stay (ED LOS) and examine clinical and operational factors associated with prolonged ED stays at Seoul-PEMC over a four-year period. This retrospective study analyzed data from the Seoul-PEMC registry between 2019 and 2023. Data on patient, prehospital, in-hospital clinical and operational factors, as well as final disposition, were obtained from the registry. Multivariable generalized estimating equation (GEE) logistic regression with patient-level clustering was performed to identify factors associated with ED LOS exceeding the 6-hour operational threshold. ED LOS exceeding 24 h was examined as a secondary extended-stay outcome. A total of 4,569 patients accounted for 5,641 visits during the study period. Median ED LOS was 5.8 h [IQR, 3.4–12.4], with 48.2% of visits exceeding 6 h and 6.8% exceeding 24 h. In the primary GEE model, restraint use (aOR = 6.38), consultation with departments other than psychiatry (aOR = 3.56), and higher triage acuity (aOR = 2.27) were strongly associated with ED LOS > 6 h. Among downstream disposition variables, admission and transfer were also associated with longer observed LOS. A broadly similar pattern was observed for ED LOS > 24 h. Self-harm/suicide-related visits were associated with lower odds of ED LOS > 6 h (aOR = 0.46). Post-hoc analyses showed longer LOS among visits involving drug intoxication and shorter LOS among those discharged against medical advice (AMA). In this four-year analysis of a regional PEMC in Korea, prolonged ED LOS was associated with multiple aspects of clinical care and downstream disposition pathways. These findings provide clinical and operational context for interpreting ED LOS in regional psychiatric emergency care.