Determinants of Emergency Department Length of Stay Using the Time Frame Emergency Care Model: A Retrospective Study
DOI:
https://doi.org/10.55018/janh.v7i3.472Keywords:
Emergency Service, Hospital, Length of Stay, Patient Flow, Time Management, TriageAbstract
Background: Timely management in the emergency department (ED) is critical for patient safety and quality of care. Prolonged Length of Stay (LOS) in the ED, often linked to delays in patient processing, can lead to poor outcomes, particularly in high-risk populations. This study aims to explore the time-related factors influencing LOS using the Time Range Guidance Model.
Methods: A retrospective cross-sectional study was conducted, analysing 377 patient records from June to August 2025. Data were extracted from electronic medical records (EMR), focusing on time intervals for initial assessment, review/consultation, and transfer phases. Multivariate regression was used to identify the factors influencing LOS.
Results: The review/consultation time (β = 0.3, p < 0.001) and transfer waiting time (β = 0.356, p < 0.001) were significant predictors of LOS. The model explained 22.6% of the variability in LOS (Adjusted R² = 0.226). Initial assessment time did not significantly correlate with LOS (r = 0.045, p = 0.321).
Conclusion: Delays in the review/consultation and transfer phases have a greater impact on ED LOS than the initial assessment. These findings suggest that optimizing these phases can improve ED efficiency and patient outcomes, particularly in resource-constrained settings such as Indonesia.
Downloads
References
Accorsi, T. A. D., Moreira, F. T., Pedrotti, C. H. S., Amicis, K. De, Correia, R. F. V., Morbeck, R. A., Medeiros, F. F., Souza, J. L. de, & Cordioli, E. (2022). Telemedicine Diagnosis of Acute Respiratory Tract Infection Patients is Not Inferior to Face-to-Face Consultation: A Randomized Trial. Einstein (São Paulo), 20, 1–9. https://doi.org/10.31744/einstein_journal/2022AO6800
Agnesia, Y., Sari, S. W., Nu’man, H., Ramadhani, D. W., & Nopianto. (2023). Buku Ajar Metode Penelitian Kesehatan. Penerbit NEM.
Aguilera, S., Quintana, L., Khan, T., Garcia, R., Shoman, H., Caddell, L., Latifi, R., Park, K. B., Garcia, P., Dempsey, R., Rosenfeld, J. V, Scurlock, C., Crisp, N., Samad, L., Smith, M., Lippa, L., Jooma, R., & Andrews, R. J. (2020). Global Health, Global Surgery and Mass Casualties: II. Mass Casualty Centre Resources, Equipment and Implementation. BMJ Global Health, 5(1), e001945. https://doi.org/10.1136/bmjgh-2019-001945
Alashker, A. W., Deib, A.-A. F. El, & Shihab, N. S. (2024). Barriers to Patient Flow in The Main Emergency Health Facilities of Tanta City, Gharbia Governorate. International Journal of Advanced Community Medicine, 7(1), 20–28. https://doi.org/10.33545/comed.2024.v7.i1a.288
Alharbi, A. A., Muhayya, M., Alkhudairy, R., Alhussain, A. A., Muaddi, M. A., Alqassim, A. Y., AlOmar, R. S., & Alabdulaali, M. K. (2023). The Pattern of Emergency Department Length of Stay in Saudi Arabia: An Epidemiological Nationwide Analyses of Secondary Surveillance Data. Frontiers in Public Health, 11, 1–9. https://doi.org/10.3389/fpubh.2023.1265707
Amirin. (2011). Populasi Dan Sampel Penelitian 4: Ukuran Sampel Rumus Slovin. Erlangga.
Belayneh, A. G., Temachu, Y. Z., Messelu, M. A., & Gebrie, M. H. (2023). Prolonged Length of Stay and its Associated Factors at Adult Emergency Department in Amhara Region Comprehensive Specialized Hospitals, Northwest Ethiopia. BMC Emergency Medicine, 23(1), 34. https://doi.org/10.1186/s12873-023-00804-y
Canellas, M., Michael, S., Kotkowski, K., & Reznek, M. (2023). Operations Factors Associated with Emergency Department Length of Stay: Analysis of a National Operations Database. Western Journal of Emergency Medicine, 24(2), 178–184. https://doi.org/10.5811/westjem.2022.10.56609
Darma, B. (2021). Statistika Penelitian Menggunakan SPSS (Uji Validitas, Uji Reliabilitas, Regresi Linier Sederhana, Regresi Linier Berganda, Uji t, Uji F, R2). Guepedia.
Hansen, K., Boyle, A., Holroyd, B., Phillips, G., Benger, J., Chartier, L. B., Lecky, F., Vaillancourt, S., Cameron, P., Waligora, G., Kurland, L., & Truesdale, M. (2020). Updated Framework on Quality and Safety in Emergency Medicine. Emergency Medicine Journal, 37(7), 437–442. https://doi.org/10.1136/emermed-2019-209290
Herlitz, S., Ohm, J., Häbel, H., Ekelund, U., Hofmann, R., & Svensson, P. (2023). Socioeconomic Status is Associated with Process Times in The Emergency Department For Patients with Chest Pain. JACEP Open, 4(4), e13005. https://doi.org/10.1002/emp2.13005
Huang, X., Yu, Q., Yu, H.-J., Pan, D., & Yu, B. (2023). Prolonged Boarding in Emergency Department with Neurologist Coverage Does Not Worse The Outcomes For Patients with Acute Ischemic Stroke. Signa Vitae, 19(4), 180–186. https://doi.org/10.22514/sv.2023.062
Iwasaki, T., Hifumi, T., Hayashi, K., Otani, N., & Ishimatsu, S. (2020). Rapid Influenza Diagnostic Test at Triage Can Decrease Emergency Department Length of Stay. JACEP Open, 1(4), 494–501. https://doi.org/10.1002/emp2.12125
Jenkins, D., Thomas, S. A., Pathan, S. A., & Thomas, S. H. (2021). Increasing Consultant-Level Staffing as A Proportion of Overall Physician Coverage Improves Emergency Department Length of Stay Targets. BMC Emergency Medicine, 21(1), 5. https://doi.org/10.1186/s12873-020-00399-8
Jenson, A., Rao, A., Mda, P., Cawe, B., Iruedo, J., Dubula, T., Stead, D., Rothman, R., & Hansoti, B. (2021). One in Four Die From Acute Infectious Illness in An Emergency Department in Eastern Cape Province, South Africa. South African Medical Journal, 111(2), 129. https://doi.org/10.7196/SAMJ.2021.v111i2.14619
Kim, M., Lee, S., Choi, M., Kim, D., Yoo, J., Shin, T. G., Lee, J.-H., Kim, S., Chang, H., & Ko, E. (2024). Factors That Predict Emergency Department Length of Stay in Analysis of National Data. Clinical and Experimental Emergency Medicine, 12(1), 35–46. https://doi.org/10.15441/ceem.24.309
Kinney, M. V, Walugembe, D. R., Wanduru, P., Waiswa, P., & George, A. (2021). Challenges in Implementing Community-Based Healthcare Teams in a Low-Income Country Context: Lessons From Ethiopia’s Family Health Teams Maternal and Perinatal Death Surveillance and Response in Low-and Middle-Income Countries: A Scoping Review of Impleme. Health Policy and Planning, 36(6), 955–973. https://doi.org/10.1093/heapol/czab011
Liberty, I. A. (2024). Metode Penelitian Kesehatan. Penerbit NEM.
Ludwick, T., Endrias, M., Morgan, A., Kane, S., Kelaher, M., & McPake, B. (2021). Challenges in Implementing Community-Based Healthcare Teams in a Low-Income Country Context: Lessons From Ethiopia’s Family Health Teams. International Journal of Health Policy and Management, 11(8), 1459–1471. https://doi.org/10.34172/ijhpm.2021.52
Magnus, D., Bhatta, S., Mytton, J., Joshi, E., Bird, E. L., Bhatta, S., Manandhar, S. R., & Joshi, S. K. (2020). Establishing Injury Surveillance in Emergency Departments in Nepal: Protocol For Mixed Methods Prospective Study. BMC Health Services Research, 20(1), 433. https://doi.org/10.1186/s12913-020-05280-9
Merahi, M. K., Argaw, R., Worku, A., Molla, T., Abayneh, B., Mathewos, N., Amare, B., Kassahun, S., Mekuria, K. N., & Elssa, M. W. (2025). Reducing Emergency Department Length of Stay For Hematology Patients of Tikur Anbessa Specialized Hospital: An Improvement Initiative. PLOS One, 20(9), e0329316. https://doi.org/10.1371/journal.pone.0329316
Mirzadeh, P., Kuk, J. L., Wharton, S., Reid, R. A., & Ardern, C. I. (2024). Healthcare Outcomes and Dispositions in Persons with Obesity Within Emergency Departments in Ontario, Canada: A Cross-Sectional Analysis of The National Ambulatory Care Reporting System (NACRS), 2018–2022. PLOS ONE, 19(9), e0311190. https://doi.org/10.1371/journal.pone.0311190
Mitchell, R., Fang, W., Tee, Q. W., O’Reilly, G., Romero, L., Mitchell, R., Bornstein, S., & Cameron, P. (2024). Systematic Review: What is The Impact of Triage Implementation on Clinical Outcomes and Process Measures in Low‐ and Middle‐Income Country Emergency Departments? Academic Emergency Medicine, 31(2), 164–182. https://doi.org/10.1111/acem.14815
Moon, S. W., Lee, J. H., Lee, H. S., Kim, H. Y., Lee, M., Park, I., Chung, H. S., & Kim, J. H. (2022). Effects of Emergency Transfer Coordination Center on Length of Stay of Critically Ill Patients in the Emergency Department. Western Journal of Emergency Medicine, 23(6), 846–854. https://doi.org/10.5811/westjem.2022.8.56039
Negasi, K. B., Tefera Gonete, A., Getachew, M., Assimamaw, N. T., & Terefe, B. (2022). 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, 22(1), 203. https://doi.org/10.1186/s12873-022-00740-3
Shbool, M. A., S. Arabeyyat, O., Al-Bazi, A., Al-Hyari, A., Salem, A., Abu-Hmaid, T., & Ali, M. (2023). Machine Learning Approaches to Predict Patient’s Length of Stay in Emergency Department. Applied Computational Intelligence and Soft Computing, 2023, 1–13. https://doi.org/10.1155/2023/8063846
Siamisang, K., Tlhakanelo, J. T., & Mhaladi, B. B. (2020). Emergency Department Waiting Times and Determinants of Prolonged Length of Stay in a Botswana Referral Hospital. Open Journal of Emergency Medicine, 8(3), 59–70. https://doi.org/10.4236/ojem.2020.83007
Slovin L.A. (1960). Sampling Methods of Research. The Journal of the American Statistical Association, 55(290), 708–713.
Stey, A. M., Kanzaria, H. K., Dudley, R. A., Bilimoria, K. Y., Knudson, M. M., & Callcut, R. A. (2022). Emergency Department Length of Stay and Mortality in Critically Injured Patients. Journal of Intensive Care Medicine, 37(2), 278–287. https://doi.org/10.1177/0885066621995426
Sujarweni, V. W. (2015). SPSS untuk Penelitian. Pustaka Baru Press.
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249. https://doi.org/10.3322/caac.21660
von Elm, E., Altman, D. G., Egger, M., Pocock, S. J., Gøtzsche, P. C., & Vandenbroucke, J. P. (2007). The Strengthening The Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines For Reporting Observational Studies. The Lancet, 370(9596), 1453–1457. https://doi.org/10.1016/S0140-6736(07)61602-X
Walugembe, D. R., Plamondon, K., Kaharuza, F., Waiswa, P., Wylie, L., Wathen, N., & Kothari, A. (2024). Exploring Variations in The Implementation of A Health System Level Policy Intervention to Improve Maternal and Child Health Outcomes in Resource Limited Settings: A Qualitative Multiple Case Study From Uganda. PLOS Global Public Health, 4(11), e0003290. https://doi.org/10.1371/journal.pgph.0003290
Yeates, K. O., Barlow, K. M., Wright, B., Tang, K., Barrett, O., Berdusco, E., Black, A. M., Clark, B., Conradi, A., Godfrey, H., Kolstad, A. T., Ly, A., Mikrogianakis, A., Purser, R., Schneider, K., Stang, A. S., Zemek, R., Zwicker, J. D., & Johnson, D. W. (2023). Health Care Impact of Implementing A Clinical Pathway For Acute Care of Pediatric Concussion: A Stepped Wedge, Cluster Randomised Trial. Canadian Journal of Emergency Medicine, 25(7), 627–636. https://doi.org/10.1007/s43678-023-00530-1
Zamzami, A. M., Felimban, A. A., Khojah, I., & Bakhsh, A. A. (2024). Factors Associated with Prolonged Emergency Department Length of Stay in A Resource-Constrained Setting. Signa Vitae, 20(2), 96–101. https://doi.org/10.22514/sv.2024.019
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Lydia Maryendi Sompie, Retno Lestari, Suryanto Suryanto

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.














