Article Data

  • Views 888
  • Dowloads 137

Original Research

Open Access

Factors associated with prolonged emergency department length of stay in a resource-constrained setting

  • Ahmad M. Zamzami1,*,
  • Ahyad A. Felimban2
  • Imad Khojah1
  • Abdullah A. Bakhsh1

1Department of Emergency Medicine, Faculty of Medicine, King Abdulaziz University Hospital, 21589 Jeddah, Saudi Arabia

2Department of Emergency Medicine, King Faisal Specialist Hospital and Research Center, 21499 Jeddah, Saudi Arabia

DOI: 10.22514/sv.2024.019 Vol.20,Issue 2,February 2024 pp.96-101

Submitted: 04 June 2023 Accepted: 17 July 2023

Published: 08 February 2024

*Corresponding Author(s): Ahmad M. Zamzami E-mail:


Prolonged length of stay (LOS) in the emergency department (ED) is a key factor in measuring ED crowding worldwide. This study aimed to identify factors associated with prolonged LOS in the ED to better understand these factors at our institution. This was a retrospective record review examining factors associated with prolonged emergency department length of stay (>6-hours). Data were collected from electronic medical records, including patient demographics, chief complaints, triage acuity level, medication administration, diagnostic testing, consultations and patient disposition. In 2019, we recorded a total of 36,068 patient visits at our ED. Of these, 6439 (17.9%) patients met our definition of prolonged ED LOS (more than 6-hours) and were included in our analysis. Using multivariate analysis, we found that consulting services carried the highest predictor for prolonged ED LOS, with an adjusted odds ratio (aOR) of 23.0 and 95% confidence interval (CI) of 20.4–25.8. Followed by medication administration (aOR 2.0, CI 1.8–2.3), laboratory investigations (aOR 1.7, CI 1.5–2.0), radiological studies (aOR 1.8, CI 1.6–2.0), and non-Saudi nationality (aOR 1.3, CI 1.2–1.4), all p < 0.01. ED LOS may be reduced by optimizing the process of laboratory/radiology testing and medication administration. More importantly however, implementing a timeframe monitoring system for consultations while emphasizing accelerated decision-making and disposition for patients can reduce ED LOS.


Length of stay; Emergency department; Prolonged ED LOS; Factors

Cite and Share

Ahmad M. Zamzami,Ahyad A. Felimban,Imad Khojah,Abdullah A. Bakhsh. Factors associated with prolonged emergency department length of stay in a resource-constrained setting. Signa Vitae. 2024. 20(2);96-101.


[1] American College of Emergency Physicians. Definition of emergency medicine. 2021. Available at: (Accessed: 19 July 2023).

[2] Al-Qahtani MF, Khubrani FY. Exploring potential association between emergency department crowding status and patients’ length of stay at a university hospital in Saudi Arabia. Open Access Emergency Medicine. 2021; 13: 257–263.

[3] Cecchi E. Emergency department length of stay (ED-LOS) as synonymous with critical and clinical risk. Internal and Emergency Medicine. 2022; 17: 191–192.

[4] Kim YE, Lee HY. The effects of an emergency department length-of-stay management system on severely ill patients’ treatment outcomes. BMC Emergency Medicine. 2022; 22: 204.

[5] Choi W, Woo SH, Kim DH, Lee JY, Lee WJ, Jeong S, et al. Prolonged length of stay in the emergency department and mortality in critically ill elderly patients with infections: a retrospective multicenter study. Emergency Medicine International. 2021; 2021: 9952324.

[6] Yoon P, Steiner I, Reinhardt G. Analysis of factors influencing length of stay in the emergency department. CJEM. 2003; 5: 155–161.

[7] Brouns SH, Stassen PM, Lambooij SL, Dieleman J, Vanderfeesten IT, Haak HR. Organisational factors induce prolonged emergency department length of stay in elderly patients—a retrospective cohort study. PLOS ONE. 2015; 10: e0135066.

[8] Negasi KB, Tefera Gonete A, Getachew M, Assimamaw NT, Terefe B. Length of stay in the emergency department and its associated factors among pediatric patients attending Wolaita Sodo University Teaching and Referral Hospital, Southern, Ethiopia. BMC Emergency Medicine. 2022; 22: 203.

[9] Ba-Aoum M, Hosseinichimeh N, Triantis KP, Pasupathy K, Sir M, Nestler D. Statistical analysis of factors influencing patient length of stay in emergency departments. To be published in International Journal of Industrial Engineering and Operations Management. 2023. [Preprint].

[10] van der Veen D, Remeijer C, Fogteloo AJ, Heringhaus C, de Groot B. Independent determinants of prolonged emergency department length of stay in a tertiary care centre: a prospective cohort study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2018; 26: 81.

[11] Kusumawati HI, Magarey J, Rasmussen P. Analysis of factors influencing length of stay in the emergency department in public hospital, Yogyakarta, Indonesia. Australasian Emergency Care. 2019; 22: 174–179.

[12] Choi Y, Jeong J, Kim BG. Admission decisions made by emergency physicians can reduce the emergency department length of stay for medical patients. Emergency Medicine International. 2020; 2020: 8392832.

[13] Wessman T, Ärnlöv J, Carlsson AC, Ekelund U, Wändell P, Melander O, et al. The association between length of stay in the emergency department and short-term mortality. Internal and Emergency Medicine. 2022; 17: 233–240.

[14] Towbin AJ, Iyer SB, Brown J, Varadarajan K, Perry LA, Larson DB. Practice policy and quality initiatives: decreasing variability in turnaround time for radiographic studies from the emergency department. RadioGraphics. 2013; 33: 361–371.

[15] Hosseininejad SM, Aminiahidashti H, Pashaei SM, Goli Khatir I, Montazer SH, Bozorgi F, et al. Determinants of prolonged length of stay in the emergency department; a cross-sectional study. Emergency. 2017; 5: e53.

[16] Traub SJ, Saghafian S, Judson K, Russi C, Madsen B, Cha S, et al. Interphysician differences in emergency department length of stay. The Journal of Emergency Medicine. 2018; 54: 702–710.e1.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.3 (2023) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time