ArticleJournal of multidisciplinary healthcare2026
Factors Associated with Length of Stay Among Patients in the Emergency Department of an Indonesian Tertiary Hospital: A Cross-Sectional Study.
Article in Journal of multidisciplinary healthcare, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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.
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