The patient-to-nurse ratio was the strongest predictor of prolonged emergency department length of stay (β 0.215), indicating that organizational factors predominantly drive system inefficiencies.
Cross-Sectional (n=229)
No
What factors are associated with prolonged Length of Stay (LOS) among patients in the Emergency Department?
Emergency Department length of stay is predominantly driven by organizational factors, particularly nursing workload, highlighting the need for system-level interventions.
Effect estimate: β 0.215 (95% CI 0.097, 0.332)
p-value: p=<0.001
Background: Prolonged Length of Stay (LOS) in the Emergency Department (ED) is a persistent global challenge associated with overcrowding, decreased quality of care, and increased patient risk. Despite established standards recommending shorter LOS, many EDs continue to experience inefficiencies. Understanding the determinants of LOS within a comprehensive framework is essential to improving ED performance. Objective: This study aimed to analyze factors associated with LOS among ED patients. Methods: A cross-sectional study was conducted in the ED of a tertiary referral hospital in Indonesia. A total of 229 patient records were enrolled using consecutive sampling over a one-month period. Independent variables comprised patient factors (age, gender, triage category), service factors (response time, assessment time), and organizational factors (patient-to-physician ratio, patient-to-nurse ratio, inpatient bed availability). Data were analyzed using univariate, bivariate, and multiple linear regression analyses. Results: The mean LOS was 468.27 minutes (7.8 hours), with 36.2% of patients exceeding 8 hours. Bivariate analysis showed that age, assessment time, and all organizational factors were significantly associated with LOS (p < 0.05). In the multivariable model, five variables remained significantly associated with LOS: age (β = 0.174; 95% CI 0.052, 0.297; p = 0.005), assessment time (β = 0.185; 95% CI 0.059, 0.311; p = 0.004), patient-to-physician ratio (β = 0.200; 95% CI 0.068, 0.332; p = 0.003), patient-to-nurse ratio (β = 0.215; 95% CI 0.097, 0.332; p < 0.001), and inpatient bed availability (β = 0.145; 95% CI 0.030, 0.260; p = 0.014). The patient-to-nurse ratio showed the strongest association with LOS in the adjusted model. Conclusion: ED LOS remains substantially prolonged and is shaped predominantly by organizational and throughput factors rather than by patient characteristics, with nursing workload emerging as the most influential organizational determinant. This throughput dominance reframes prolonged LOS as a system-level rather than a purely clinical problem, underscoring the need for system-oriented interventions particularly workload optimization, staffing adequacy, and improved hospital-wide patient flow to enhance ED efficiency and reduce LOS. Keywords: emergency department, length of stay, workload, patient flow, hospital management
Kurhayati et al. (Mon,) conducted a cross-sectional in Emergency Department patients (n=229). Patient-to-nurse ratio was evaluated on Length of Stay (LOS) (β 0.215, 95% CI 0.097, 0.332, p=<0.001). The patient-to-nurse ratio was the strongest predictor of prolonged emergency department length of stay (β 0.215), indicating that organizational factors predominantly drive system inefficiencies.