Factors Associated With Prolonged Emergency Department (ED) Length of Stay (LOS) at a Tertiary Care Hospital in Nepal: A Cross-Sectional Study.

Authors

Pratisha Pradhan, Kabita Hada Batajoo, Alok Kumar, K C Bhushan Bikram, Sneha Pradhananga, Trishna Shrestha

Published in

Emergency medicine international. Volume 2026. Pages 8919991. Epub Oct 06, 2026.

Abstract

Emergency department (ED) length of stay (LOS) is an important indicator of healthcare efficiency and patient flow. The duration of ED stay is influenced by a complex interaction of patient-related, clinical and system-level factors. Prolonged LOS (> 4 h) contributes to ED overcrowding and adverse patient outcomes. However, limited data exist regarding factors influencing ED LOS in Nepal.
A descriptive cross-sectional study was conducted in the ED of KIST Medical College and Teaching Hospital (MCTH), a tertiary care hospital in Lalitpur, Nepal, from May 15, 2025, to May 30, 2025. All patients presenting to the ED during the study period were eligible for inclusion. Consecutive patient records were reviewed. ED LOS was defined as the time from patient arrival to ED exit. LOS was summarized using median and interquartile range (IQR). Group differences were assessed using the Mann-Whitney U and Kruskal-Wallis tests. Variables with p < 0.20 in univariate analysis were entered into a multivariable logistic regression model to identify factors independently associated with prolonged ED LOS (> 4 h). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported.
A total of 395 patients were included. The median ED LOS was 3.58 h (IQR 2.42-5.00). A total of 161 (40.8%) experienced prolonged ED LOS, while 234 (59.2%) had a LOS of ≤ 4 h. In univariate analysis, age, triage category, number of specialty consultations, payment method and requirement for advanced investigations were significantly associated with prolonged ED LOS (p < 0.05). On multivariable logistic regression analysis, increasing age, time of presentation and number of specialty consultations were independent predictors of prolonged ED LOS. Patients requiring single specialty consultation had higher odds of prolonged LOS (aOR 3.12; 95% CI 1.34-7.28), while those requiring multiple consultations had markedly higher odds (aOR 13.41; 95% CI 4.47-40.20). Presentation during night shift was associated with lower odds of prolonged LOS compared with morning shift (aOR 0.29; 95% CI 0.16-0.52).
ED LOS in this tertiary care hospital was primarily influenced by patient age, time of presentation, consultation processes and administrative factors. Strengthening interdepartmental consultation processes and improving ED workflow efficiency may help reduce prolonged ED stay and overcrowding.

PMID:
42846122
Bibliographic data and abstract were imported from PubMed on 08 Oct 2026.

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