https://orcid.org/0000-0003-4275-1200
Figures
Abstract
Introduction
Patient length of stay is a crucial measure of the emergency department, and it is a vital indicator of health services to evaluate its efficacy, patient care, organizational management, and health care system. Despite this, there are a few studies conducted on pediatric emergency length of stay in developing countries. Therefore, this study serves as input for evidence of pediatric emergency length of stay and associated factors in public hospitals.
Methods
An institution-based cross-sectional study was conducted among children who attended in pediatric emergency department of Eastern Ethiopia public hospital from May 01 to Jun 31, 2022. A total of 761 children were selected by systematic sampling technique and interview using structured questionnaires. After data is collected and cleaned, entered using Epi data version 4.6 and then exported to Stata version 14.1 for analysis. Finally, an AOR with a 95% CI was computed, and variables with a P-value < 0.05 in the multivariable analysis were taken as significant factors for prolonged length of stay.
Result
The prevalence of prolonged length of stay in the emergency ward was 214 (72%). Living in a rural residence ([AOR = 1.65, 95% CI (1.10–2.48)], having a duration of pain > = 12 ([AOR = 1.92, 95% CI (1.13–3.25)], waiting time > = 5 minute ([AOR = 2.24, 95% CI (1.1–4.248541)], having comorbid illness ([AOR = 1.92, 95%CI, 1.13–3.25)], and higher acuity level and absence of medication in the hospital were ([AOR = 2.26, 95%CI (1.02–2.46]) were significantly associated factors for prolonged length of stay.
Conclusion and recommendation
This study revealed that more than two-thirds of children admitted to pediatric emergency had prolonged lengths of stay. This result indicated that higher proportion of the length of stay in pediatric emergency in Eastern Ethiopian public hospitals compare to national. Hence, it is better to give priority to strengthening the focused evaluation of important variables and manage accordingly.
Citation: Melkamu N, Faris A, Yigezu M, Hailu M, Atle A, Kasahun M, et al. (2025) Length of stay in the pediatrics emergency department and associated factors among pediatrics patients in Eastern Ethiopia public hospital, Ethiopia 2022. PLoS ONE 20(1): e0313146. https://doi.org/10.1371/journal.pone.0313146
Editor: Inge Roggen, Universitair Kinderziekenhuis Koningin Fabiola: Hopital Universitaire des Enfants Reine Fabiola, BELGIUM
Received: March 13, 2024; Accepted: October 19, 2024; Published: January 7, 2025
Copyright: © 2025 Melkamu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Abbreviations: ED, Emergency Department; LMICs, Low and Middle-Income Countries; EM, Emergency Medicine; LOS, Length of Stay; ETAT, Emergency Triage Assessment and Treatment; PLOS, Prolonged Length of Stay; ETB, Ethiopian Birr; USA, United States of America; FMHO, Federal democratic republic of Ethiopia ministry of health
Introduction
Pediatrics emergency Length of stay (LOS):- is defined as the period starting from registration of patients to their discharge, admission, or referral [1, 2]. Globally, over the last 20 years, Emergency Department (ED) visits have increased by 65% within 9years, and evidence has shown that annual visits have increased faster than the population growth [3, 4]. The daily ED patient flow comprises one-quarter-of of pediatric consultations in Western countries [5]. A study conducted in the United States of America (USA) in 2018 states the annual Pediatric ED visits were nearly 30 million, with 25.6% o being children less than 15 years old. Additionally, study conducted in Australia showed a 21% increase within 2years [6, 7]. This trend may be even more pronounced in developing countries, where a quadruple burden of disease and inadequate resources are prevalent [8].
The ED in the hospital is designed for prompt assessment and stabilization of patients arriving at the hospital in need of immediate care [9]. Upon arrival at the hospital, children are triaged, treated, and then either transferred to a pediatric inpatient ward or discharged. Prolonged ED stay is a worldwide problem that may affect access to healthcare and the quality of service provided, as time is considered a critical component in the quality of ED [10, 11]. However, the cut-offs defining prolonged ED LOS vary across countries ranging between 4 and 48 hours [12], with most Western nations having a range of 4 to 8 hours, most of African having 24–48 hours, and Ethiopia having more than 24 hours [1, 8, 13, 14].
Despite the discrepancy in the cut-off point to determine prolonged LOS, it is a vital factor for ED overcrowding, decreased patient satisfaction, ambulance diversion, and poor clinical outcomes [15]. Crowding and limited resources due to prolonged LOS may reduce access for new admissions, delay care and workups, prolong pain and suffering, as well as delay therapeutic interventions. This puts patients at risk for morbidity, and mortality as well as decreased patient satisfaction. It also increases the socioeconomic burden on parents and limits the proper utilization of healthcare facilities [16, 17]. Unnecessary emergency stays result in overcrowding and overcapacity of ED [17], which is linked to increased patient morbidity, mortality, and dissatisfaction [18, 19]. Children are particulary vulnerable to hazards due to their fragility and differences in developmental stages, so the longer they stay in the ED, the greater the risk. Therefore, identifying potential variables for LOS will aid in developing a tailored intervention to avoid prolonged LOS [2, 20].
Previously, studies have indicated that various factors were associated with prolonged LOS in pediatric emergencies such as arrival time, change in night shift, orders of imaging, referral type, orange triage category, duration of pain, age, and sex [20–22].
While governmental and non-governmental organizations emphasize reducing morbidity and mortality of children, the problems are often higher on this age group [23]. Particularly in low and middle-income countries (LMICs) where late presentation, delayed interventions, financial constraints, unavailability of life-saving equipment and inadequate support services, and insufficient health workforce are prevalent [16]. The situation is worse in Ethiopia, where the ratio of pediatricians per population is low, and there are no emergency pediatrician [24]. To reduce LOS in ED the Ethiopian government aggressively working to reduce child mortality through implementation of different programs, such as standardized Emergency Triage Assessment and Treatment (ETAT) training, triage category, increasing healthcare workforce, and pediatrics emergency unit care [20]. Previous studies have suggested that prolonged LOS can be reduced through triage standards adjustment and ED process redesigns [2]. Nevertheless, pediatric LOS in the ED remains a major problem.
Despite a considerable body of literature from developed countries, the existing information is inadequate in LMICs to inform clinical or service-planning decisions. A deeper understanding of the contributing factors of pediatric ED LOS could help identify patients who require special intervention or resources to prevent a prolonged LOS [20]. Identifying the cause is also essential for developing appropriate interventions and strategies [25]. Moreover, studying LOS is used for resource consumption, effective planning, and management [18, 19]. As children are prone to emergency conditions, studies regarding LOS in ED play a vital role. Despite this, studies related to LOS in pediatric emergencies in Ethiopia are scarce [20]. Therefore, this study assess the Length of Stay in the Pediatrics Emergency Department and associated factors among pediatric patients in Eastern Ethiopia public hospitals, Ethiopia 2022.
Materials and methods
Study design and setting
An institutional-based multi-center cross-sectional study was used to assess the length of stay in pediatrics emergency and associated factors among children admitted at Eastern Ethiopia Public Hospital. The study was conducted from May 01 ‐ June 30, 2022, among children admitted at selected Eastern Ethiopia Public Hospitals. Three hospitals were randomly selected considering the availability of the pediatrics emergency unit that includes Chiro General Hospital, Hiwot Fana Referral Hospital and Dilchora Referral Hospital.
Chiro Hospital is a general hospital that is found in the western Hararghe zone, Oromia regional state, Eastern Ethiopia. Chiro Hospital was established in 1969 and Chiro town is located 326 km from Addis Ababa in the eastern direction. According to the 2017 G.C. town health office plan, the estimated total population of the town is 1,607,922. Chiro General Hospital is a zonal hospital that provides emergency management of pediatrics and neonatal care services in the western Hararghe zone. The hospital has given services to more than 1.6 million individuals around the area [26]. The pediatric emergency of Chiro General Hospital contains 14 beds.
Hiwot Fana Specialized Referral Hospital is located in Harar town in the Eastern part of Ethiopia at a distance of 526km away from Addis Ababa, the capital city of Ethiopia. According to the 2007 census report of the Central Statistical Agency, the total population of the region is estimated to be 183, 415, of which 92,316 are males and 91, 099 females. Hiwot Fana Specialized Referral Hospital is the only tertiary hospital that provides different services for approximately 5.8 million people in the catchment area. In the town, there are 45 health facilities (34 health posts, 8 health centers, and 5 hospitals [27].
The third site is Dilchora referral Hospital located in Dire Dawa city administration at a distance of 515 km away from the capital city of Ethiopia, Addis Ababa. Based on the 2019/2020 population projection Central Statistical Agency of Ethiopia: Dire Dawa city administration has a total population of 506,609 (248,238 male and 258,371 females). The administration has 6 hospitals (2 governmental, 2 private, 2 other non-governmental, and 1 other governmental hospital), 15 Health centers (8 urban and 7 rural), 34 health posts, 56 primary, medium, and specialty clinics, and also 30 pharmacies, 42 drug vendor and 4 private hospital pharmacies found in the Administration. Dilchora Hospital is the only referral hospital in the city.
Population and sample
The study population includes all children who attended in pediatric emergency department at the selected public hospital in Eastern Ethiopia, in 2022. Children attending the pediatric emergency department during the data collection period were included in the study and patients who leave the the wards without notifying the staff and immediate death were excluded.
Sample size determination and sampling procedure
The sample size was calculated using single population proportion formula based on the following assumptions Za/2:-value of standard normal distribution (z = 1.96) with a confidence interval of 95%, P the prevalence of pediatrics ED LOS, 79.70% [20], d margin of error to be tolerated and taken 3%., and considering 10% non-response rate, final sample size was 761. Finally, data was collected from a total of 761 children attending a pediatric emergency.
Considering the availability of a pediatrics emergency ward three public hospitals in Eastern Hospital were selected. The sampling frame of patients in each of the hospitals was obtained from the previous four months and averages were taken. The total sample size was proportionally allocated for each three hospitals depending on the load of patients registered in the past four months. A systematic random sampling technique was used to select the study participants. To determine the starting point, the lottery method was used. Subsequently, the sampling interval (k) was calculated by dividing the expected number of children visiting the ED during the study period (N) with the determined sample size (n) of respondents (2180/761 = 2.8). Finally, using a systematic random sampling technique, one in every 3 attendant children pairs was selected until the required sample was reached (Fig 1).
Data collection tools and technique
Data were collected using structured interview questionnaires and standardized tools adapted from a study conducted in Wolaita [20] which was validated. It was prepared in English, then translated into Amharic, Afaan Somalia, Harari, and Afaan Oromo language, and then retranslated to English to check for consistency. The study participants’ language fluency was asked and interviewed based on their choice. A total of thirteen BSc nurses and 3 supervisors were recruited for data collection and supervision. Data collectors were trained for two days before data collection. Finally, the trained data collectors collected data from the patients following presentation, admission, and before discharge from the ED through respondent interviews, observation, and medical record review.
The data collection procedure will be illustrated as follows: first, eligible patients will be identified by data collectors at the triage room while resident staff triage patients on arrival. Hence at arrival, time and other presentation characteristics were recorded in the triage room. Following this, other information such as socio-demographic characteristics and other organizational-related factors was obtained through interviews, chart review, and observation of patients at different treatment points. Finally, information such as diagnostic investigations and overall treatments were recorded from medical records, whereas the overall length of stay at the department and final disposition were recorded right before the patient was discharged from the ED. Later, essential time-related factors and the overall length of stay between presentation and discharge from ED.
Variables of the study
The dependent variable was Length of stay (prolonged, not prolonged), whereas the independent variables were socio-demographic (age, sex, residence, language, income, religion, mode of arrival, education level, marital status, and occupation), time-related factors (time of arriving, date of arriving, duration of pain, and waiting time), clinically related factors (chief compliant, referral status, triage category, prior treatment, diagnosis, comorbid illness, mental status and outcome of the patient), organizational related factors (examiners, diagnostic investigations, discharge, admission, refer, shift change and experience)
Operational definition
Pediatrics emergency department length of stay: is the total length of time for all emergency case attendants who stay in the emergency room from minutes to hours (days) starting from registration. According to Ethiopian hospital services transformation guidelines: patients’ LOS in the emergency department should not be greater than 24 hours. Then transfer to wards has been facilitated before 24 h for proper inpatient admission if necessary [13]. Waiting time is calculated by subtracting the ED registration time from the time a patient was placed in an ED treatment room [21]. Prolonged length of stay: defined as a patient stays in the emergency department > 24 hours [13, 20]. Not prolonged length of stay: when a patient stays in the emergency department < 24 hrs. [13, 20].
Ethical approval and consent to participate
Ethical clearance was obtained from the Dire Dawa University Institutional Review Board in a letter protocol number DDU-IRB-2022-070 and a Permission letter was obtained from Hiwot Fana referral hospital, Chiro General Hospital, Dilchora referral hospital management, and the pediatric emergency unit head. The study participants were informed about the purpose and importance of the study. The participants were assured the right to refuse or withdraw at any time. Finally, voluntary written and signed informed consent was obtained from the study participant or their parents/legal guardians before data collection. The Confidentiality of the study participants was maintained throughout the research process by giving the code for participants. The study participants were also informed that data were kept private and confidential, and only used for research purposes.
Data quality control and management
To ensure quality of data tool translated into the local languages Amharic, Afaan Somalia, Harari, and Afaan Oromo. The data collectors were recruited based on their language fluency in Amharic, Afaan Somalia, Harari, and Afaan Oromo. The recruited data collectors trained for two days on the objective, confidentiality of information, informed consent, and techniques of interviews. Three supervisors supervised the data collectors and reported daily. Before data collection, pretest was conducted on 5% of the total sample and modified accordingly. The collected data checked for completeness and consistency on the day of data collection. Simple frequencies and cross-tabulation were done for missing values and cross-checked with hard copies of the collected data.
Data analysis
Data clean up and cross-checked before analysis and entered to Epi data version 4.6, finall exported to Stata version 14.1 for analysis. The descriptive statistics computed to summarize the descriptive results and presented in texts, tables, and figures. The model fittnes checked by the Hosmer-Lemeshow goodness of a fit test and ROC curve (Receiver Operating characteristic Curve). Multicolinarity checked using VIF(Variance Inflation Factors). A bi-variable logistic regression model was used to assess statistical association between the outcome variable and every independent variable. Variables that showed statistical significance during bi-variable analysis at P-value ≤ 0.25 entered to multivariable logistic regression. Finally the strength of association are taken with adjusted odds ratios (AOR) with a 95% Confidence interval at a p-value < 0.05.
Result
Socio-demographic characteristics
In this study, a total of 761 children interviewed and had response rate of 100%. About 400(52%) of study participants were female. The median age of study participants was 2years and had IQR of 5.3. About 358 (47%) of respondents are Muslim religions followers, followed by Orthodox religion 216 (28%). Concerning the educational status of the caregivers, more than 2/3rd of study participants have formal education and can speak more than one languaghe (Table 1).
Presentation time characteristics
Regarding presenting characteristics, half of the study participants presented during the morning, and about 548(72.01%) of the study participants arrived on the weekdays. About 316 (41.52%) participants used taxis as a means of transportation, followed by an ambulance (Table 2).
Clinical and organizational related factors
As shown below (Fig 2), the leading chief complaints of study participants in pediatrics emergency on admission were respiratory-related complaints 264 (34.69%) followed by Gastroenteritis infection 178(23.39%).
As shown below (Table 3), the clinical characteristics of study participants during admission, more than half of study participants went directly to the hospital 401(52.69%), and the majority of them had taken various medications 573(75.30%) before arrival to the hospital. Concerning preexisting comorbid disease, the majority of respondents, 596 (78.32%), had not had the comorbid disease, and nearly 45% of study participants waited more than 5 minutes. Regarding the triage category, the majority of them are categorized under red level 222(29.17), followed by yellow category 216(28.38). Regarding laboratory investigation, almost all study participants had an ordered investigation. Nearly two-thirds of the study participants had sent a laboratory investigation. In addition, most study participants had gotten order medication in the hospital 681 (91.90%).
Pediatrics emergency department length of stay
The prevalence of pediatrics ED LOS greater than 24 hours was 547(72%). The children stayed in the ED for a minimum of 1.30 hours. and a maximum of 362 with a median of 48 hours (Fig 3).
Bi-variable and multivariable logistic regression analysis analysis
In the Bi-variable logistic regression age of the children, sex, educational level, residence language, duration of pain, distance from the hospital, time arrivals, waiting time, mode of arrival, refer status, comorbidity, prior treatment, triage category and medication whereas, on the multivariable logistic regression variables such as residence, duration of pain, waiting time, comorbidity, triage category, and presence of medication were significantly associated with the prolonged length of stay (Table 4). The appropriateness of the model was checked using the Hosmer-Lemeshow test (P = 0.51) and graphically ROC = 0.81 (Fig 4).
This study showed that the odds of prolonged LOS among children age > 5 years are 2 times than the lower age group ([AOR = 2, 95% CI (1.18 3.14)]. Keeping other variables constant, children residing in rural areas were 1.65 times ([AOR = 1.65, 95% CI (1.10–2.49)] more likely to prolong than urban. Those who have comorbid illness had 1.92 times the odds of prolonged emergency than their counterpart ([AOR = 2, 95% CI (1.14–3.26)]. Regarding the triage category, children in the red, orange, and yellow had odds of 2.9, 2.5, and 2.7 times more likely to prolong in the emergency than the green category, respectively. Controlling other variable constants, children who got medication in the hospital were 37.2% less likely to prolong than those who didn’t get it in the hospital. Concerning waiting time, children who waited without treatment for more than 5 minutes had 2.24 times the odds of prolonged stay compared to their counterparts. Keeping other variables constant odds of children having pain for more than 3 days had 3.91 times more to prolonged than less than 12 hours.
Discussion
Most patients view the ED as their front doors to the healthcare system; their time in the ED, doesn’t end until they are either sent home, admitted to the hospital, or transferred to another facility. Length of stay in the ED is one of the most important metrics for evaluating an ED’s overall effectiveness and level of care. The duration of stay in an ED varies depending on the country and different factors. Therefore, this study assesses the LOS in the pediatric emergency department and associated factors among pediatric patients in Eastern Ethiopia public hospitals, Ethiopia 2022.
The overall proportion of the prolonged LOS in the pediatrics emergency unit was 72% [95%, CI (68.-75)]. This result is in line with a study conducted in Botswana 72.5% [28]. However, it’s higher than the studies conducted in Egypt, Nigeria, Netherlands, Iran, and Indonesia [11, 16, 21, 29]. These differences may be due to the differences in organizational structure, administration, the health system of the organization, and the availability of organized services [17]. In addition factors such as cut of point to define prolonged LOS, difference in inclusion criteria and study year may play significant roles. Studies conducted in Egypt and Iran used the mean and accelerated failure time (AFT) model as a cut-off point to define prolonged LOS. Additionally, studies conducted Netherlands and Iran use cut-off points of 4 hrs. and 6 hrs. respectively. Furthermore, studies show that variations in staffing, infrastructure, accessibility of medical equipment, and other organizational processes may contribute to this variation. Moreover, in a study conducted in Nigeria, the majority of study participants were reviewed within 15 minutes, had timely consultation and adequate subspecialties may contributed to the discrepancy [8, 16, 21].
However, length of stay in our studies area were lower than studies conducted Wolaita, 79.70% and southern Ethiopia, 91.5% [17, 20]. This difference may be due to the difference in study year conducted i.e. during COVID 19 pandemic and both studies conducted in single institutions, additionally study conducted in southern Ethiopia includes adult age and have stated lack of admission of beds to inpatient as a factor for prolonged LOS [17, 30].
Concerning factors associated, the study showed that the odds of prolonged LOS among children aged >5 years were 1.93 times odds of prolonged than lower age group ([AOR = 1.93, 95% CI (1.18–3.15)]. This result is in line with studies conducted in Iran, Botswana, and Taiwan [22, 28, 30]. This may be due to increasing age associated with increasing risk of having comorbidity and disease complexity [31].
Regarding geographical residents, the odds of prolonged length of stay among children residing in rural were 1.65 times [(AOR = 1.6, 95% CI (1.07 2.39)] more likely to prolong than in urban. This is supported by a systematic review conducted in England which concludes that geographical variation affects LOS [32]. In addition, studies conducted in China, Italian and, Nigeria have reported that place of residence has a significant relationship with pediatric emergency LOS [2, 16, 30, 33, 34]. Furthermore, a cross-sectional study done in south Iran revealed that LOS has a significant relationship with place of residence [14]. This may be due to children mostly depending upon the caregivers, so families from rural residences will have delays in the decision due to lack of health care service, indirect cost, lack of transport, and other reasons [2, 35].
Another factor for prolonged ED LOS in our study was having comorbid illness, those who have comorbid illness had 1.92 times odd of prolonged in emergency than their counterpart ([AOR = 1.95, 95% CI (1.16 3.29)]. This result is in line with study Australia and, Netherlands [36, 37]. In addition, a systematic study conducted worldwide has stated that comorbidity was associated with ED admission, PLOS as well as health care costs [38, 39]. This may be due to these patients mostly being admitted to tertiary hospitals with multiple chief complaints that require several diagnostic investigations, consultation, and sophisticated care [21]. Therefore, the complexity of the care and delays caused by diagnostic testing and consultations could contribute to PLOS [21, 40].
The present study showed triage levels having red, orange, and yellow categories had nearly 2.5 times the odds of prolonging the length of stay compared to the green category. This result is supported by studies conducted in Wolaita, Switzerland, USA, and Taiwan, in 2017 [2, 11, 20, 41, 42]. This might be due to the patients on triage level II have high acuity with increased disease severity, the patients come in need of lots of care, and the emergency interventions require more time, and intensive treatment. In addition, triage level interpretation, and unique characteristics of the local ED and national health system are different at other hospitals [11, 43]. This might be due to when the acuity level of the disease is increased, the patients come in need of lots of care, and the emergency interventions require more time, intensive treatment is given, likewise, the nature of the disease in the pediatrics population by itself is challenging to manage easily for health professionals, and the higher the acuity level the more challenged and physicians require more time to decide the appropriate place for the patient’s weather inpatient ward, refer to other hospital or discharge. In addition, patients with high acuity levels may need experts (pediatrician) and investigation, this will increase waiting time for the pediatrician and to got ordered investigation, which may contribute for prolonged LOS [22].
Controlling other variable constants those who got medication in the hospital were 39.2% less likely to prolong than those who didn’t have it in the hospital. This is in line with a study conducted in Wolaita, Ethiopia. This may be due to not getting medication in the hospital will make the patients search the drugs outside the hospital compound which hinders the intake of prescribed drugs and adversely affects the patient’s recovery [20].
Concerning waiting time those who have waited without treatment for more than 5 minutes had 2.93 times odd prolonged stay compared to their counterpart. This is comparable with studies conducted in the USA, Botswana, Taiwan, and South Africa [28, 41, 42, 44]. This could be explained by the longer the patients stay in waiting area, its ends up crowding of ED. This would delayed the diagnosis and treatment of their current conditions that would increase the complexity and worsening of the diseases [45]
Keeping other variables constant, the odds of children having pain for more than 72 hours were 2 times prolong their stay compared to those with pain reported for less than 12 hours. This result supported by a study conducted in Wolaita, Ethiopia. This could be explained by patients that had duration of pain of 13–24 hours without treatment might come with an acute life-threatening emergency that complex and worse disease progression [20].
Conclusion and recommendation
Conclusion
More than two-thirds of children admitted in pediatric emergencies had prolonged LOS. This result indicates a higher proportion of the LOS in a pediatric emergency in Eastern Ethiopia public hospitals compared to national. Being resides in rural, having a higher duration of pain, time arrivals, long waiting times, having a comorbid illness, having red, yellow, and orange triage categories, and the presence of medication in the hospital were significant factors associated with prolonged LOS.
Recommendation
Based on this study we would like to recommend the Ethiopian minister of health and other concerned bodies to enhance the accessibility of health services to the rural residents. Designating a temporary department to accommodate admitted patients who are waiting for beds and strengthening the hospital pharmacy to accommodate the needs of customers. To strengthen the monitoring and evaluation of the LOS in ED and use different strategies to decrease the length of stay. The health workers also need to provide health information for parents or guardians regarding the importance of early access of medical service for children health. Further research that will incorporates important variables using a mixed study design and further research using a prospective cohort study design. Parents (caregivers) need to be aware of the pain of their children and promptly visit health facilities. The health workers better consider this variable being in rural residents, duration of pain, time of arrival, waiting time, having a comorbid illness, higher triage level, and absence of medication in the hospital were variables that prolonged LOS. Therefore, health workers need to provide more emphasis on these variables to reduce the LOS in the ED.
Acknowledgments
We would like to thank the Hiwot fana specialized referral hospital, Chiro general hospital and Dilchora referral hospital for their cooperation and permitting their cooperation in providing information and we would like to give great appreciation for data collectors for their great collaboration and tolerance during data collection for this research work.
References
- 1. Bashkin O, Caspi S, Haligoa R, Mizrahi S, Stalnikowicz RJIjohpr. Organizational factors affecting length of stay in the emergency department: initial observational study. Israel journal of health policy research. 2015;4(1):1–7. pmid:26473027
- 2. Hofer KD, Saurenmann RKJEjop. Parameters affecting length of stay in a pediatric emergency department: a retrospective observational study. 2017;176(5):591–8.
- 3. Boudi Z, Lauque D, Alsabri M, Östlundh L, Oneyji C, Khalemsky A, et al. Association between boarding in the emergency department and in-hospital mortality: A systematic review. PloS one. 2020;15(4):e0231253. pmid:32294111
- 4. Hsu C-M, Liang L-L, Chang Y-T, Juang W-CJJotFMA. Emergency department overcrowding: Quality improvement in a Taiwan Medical Center. 2019;118(1):186–93.
- 5. Georgio G, Guttmann A, Doan QHJTJoem. Emergency department flow measures for adult and pediatric patients in British Columbia and Ontario: a retrospective, repeated cross-sectional study. 2017;53(3):418–26.
- 6. Bekmezian A, Chung PJ, Cabana MD, Maselli JH, Hilton JF, Hersh ALJPec. Factors associated with prolonged emergency department length of stay for admitted children. 2011;27(2):110–5.
- 7. Gill SD, Lane SE, Sheridan M, Ellis E, Smith D, Stella JJEMA. Why do ‘fast track’patients stay more than four hours in the emergency department? An investigation of factors that predict length of stay. 2018;30(5):641–7.
- 8. Okoronkwo N, Chappjumbo AJM. Pattern of morbidity and mortality of childhood illnesses at the children emergency room of Abia State University Teaching Hospital, Aba, Nigeria. MEDICAL. 2015:70.
- 9. Ahmed AA, Ibro SA, Melkamu G, Seid SS, Tesfaye T. Length of Stay in the Emergency Department and Its Associated Factors at Jimma Medical Center, Southwest Ethiopia. Open Access Emergency Medicine: OAEM. 2020;12:227. pmid:33116958
- 10. Riney LC, Brokamp C, Beck AF, Pomerantz WJ, Schwartz HP, Florin TAJPEC. Emergency medical services utilization is associated with community deprivation in children. 2019;23(2):225–32.
- 11. Kusumawati HI, Magarey J, Rasmussen PJAec. Analysis of factors influencing length of stay in the Emergency Department in public hospital, Yogyakarta, Indonesia. Australasian emergency care. 2019;22(3):174–9. pmid:31253476
- 12. Nash KA, Zima BT, Rothenberg C, Hoffmann J, Moreno C, Rosenthal MS, et al. Prolonged emergency department length of stay for US pediatric mental health visits (2005–2015). Pediatrics. 2021;147(5). pmid:33820850
- 13.
FMOH) FDRoEMoH. Ethiopian hospital services transformation guidelines(EHSTG). Ethiopia2018.
- 14. Baniasadi T, Kahnouji K, Davaridolatabadi N, Teshnizi SHJBhsr. Factors affecting length of stay in Children Hospital in Southern Iran. 2019;19(1):1–6.
- 15. Mahmoud I, Hou X-y, Chu K, Clark MJWjoem. Language affects length of stay in emergency departments in Queensland public hospitals. 2013;4(1):5.
- 16. Enyuma CO, Anah MU, Pousson A, Olorunfemi G, Ibisomi L, Abang B, et al. Patterns of paediatric emergency admissions and predictors of prolonged hospital stay at the children emergency room, University of Calabar Teaching Hospital, Calabar, Nigeria. 2019;19(2):1910–23.
- 17. Negari KG, Rodamo KM, Hirigo AT. Factors associated with the length of stay in emergency departments in Southern-Ethiopia. BMC research notes. 2019;12(1):239. pmid:31023367
- 18. Miller R. Nurse-Driven Protocols in the Pediatric Emergency Department: A Systematic Review: Walden University; 2020.
- 19. Dayal P, Horeczko T, Wraa C, Karsteadt L, Chapman W, Bruhnke L, et al. Emergency medical services utilization by children. 2019;35(12):846–51.
- 20. Tezera N, Negasi KB, Tefera A, Getachew M. Length of stay in the emergency department and its associated factors among pediatrics patients attending at Wolaita Sodo University Teaching and Referral Hospital, Southern, Ethiopia, 2021. 2021.
- 21. van der Veen D, Remeijer C, Fogteloo AJ, Heringhaus C, de Groot BJSjot, resuscitation, medicine e. 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(1):1–9.
- 22. Chaou C-H, Chen H-H, Chang S-H, Tang P, Pan S-L, Yen AM-F, et al. Predicting length of stay among patients discharged from the emergency department—using an accelerated failure time model. PloS one. 2017;12(1):e0165756. pmid:28107348
- 23. Ambaye M, Tefera MJEJoHD. Pattern of admissions to the pediatric emergency unit of Tikur Anbessa Hospital in Addis Ababa, Ethiopia (2012–2013 GC). 2016;30(2):88–93.
- 24. Jofiro G, Jemal K, Beza L, Heye TB. Prevalence and associated factors of pediatric emergency mortality at Tikur Anbessa specialized tertiary hospital: a 5 year retrospective case review study. BMC pediatrics. 2018;18(1):1–10.
- 25. Moskop JC, Geiderman JM, Marshall KD, McGreevy J, Derse AR, Bookman K, et al. Another look at the persistent moral problem of emergency department crowding. 2019;74(3):357–64.
- 26. Katore FH, Gurara AM, Beyen TKJIBPC. Determinants of Preeclampsia Among Pregnant Women in Chiro Referral Hospital, Oromia Regional State, Ethiopia: Unmatched Case–Control Study. 2021;14:163.
- 27. Abdurke Kure M, Abdo Komicha M, Egata GJJWsHC. Magnitude of Low Birth Weight and Associated Factors among Women who gave Birth in Public Hospitals of Harari Regional State, Eastern Ethiopia. 2021;10(534):2167–0420.21.
- 28. Siamisang K, Tlhakanelo JT, Mhaladi BB. Emergency department waiting times and determinants of prolonged length of stay in a Botswana referral hospital. Open Journal of Emergency Medicine. 2020;8(3):59–70.
- 29. Nassar MMAA, Hassan BA, El-Saadany HFJTEJoHM. Factors Affecting Length of Stay in Pediatric Emergency Department in Zagazig University Hospital. 2020;81(4):1872–7.
- 30. Hosseininejad SM, Aminiahidashti H, Pashaei SM, Khatir IG, Montazer SH, Bozorgi F, et al. Determinants of prolonged length of stay in the emergency department; a cross-sectional study. Emergency. 2017;5(1).
- 31. Bortnick AE, Epps KC, Selzer F, Anwaruddin S, Marroquin OC, Srinivas V, et al. Five-year follow-up of patients treated for coronary artery disease in the face of an increasing burden of co-morbidity and disease complexity (from the NHLBI Dynamic Registry). The American journal of cardiology. 2014;113(4):573–9. pmid:24388624
- 32. Busby J, Purdy S, Hollingworth WJBhsr. A systematic review of the magnitude and cause of geographic variation in unplanned hospital admission rates and length of stay for ambulatory care sensitive conditions. 2015;15(1):1–15.
- 33. Simkhada P, Acharya S, Lama R, Dahal S, Lohala N, Thapa AJJJotNMA. Emergency stay duration of patients in emergency department of a tertiary care hospital in Nepal: a descriptive cross-sectional study. 2020;58(222):84.
- 34. Chaou C-H, Chiu T-F, Yen AM-F, Ng C-J, Chen H-HJM. Analyzing factors affecting emergency department length of stay—using a competing risk-accelerated failure time model. 2016;95(14).
- 35. Flabouris A, Hart GK, Nicholls A. ’Patients admitted to Australian intensive care units: Impact of remoteness and distance travelled on patient outcome. Critical care and resuscitation. 2012;14(4):256–67. pmid:23230874
- 36. van der Linden MC, Meester BE, van der Linden N. Emergency department crowding affects triage processes. International emergency nursing. 2016;29:27–31. pmid:26970907
- 37. Fulbrook P, Jessup M, Kinnear F. Implementation and evaluation of a ‘Navigator’role to improve emergency department throughput. Australasian Emergency Nursing Journal. 2017;20(3):114–21. pmid:28624270
- 38. McPhail SM. Multimorbidity in chronic disease: impact on health care resources and costs. Risk management and healthcare policy. 2016:143–56. pmid:27462182
- 39. Zulman DM, Chee CP, Wagner TH, Yoon J, Cohen DM, Holmes TH, et al. Multimorbidity and healthcare utilisation among high-cost patients in the US Veterans Affairs Health Care System. BMJ open. 2015;5(4). pmid:25882486
- 40. Van Der Linden MC, De Beaufort RA, Meylaerts SA, Van Den Brand CL, Van Der Linden N. The impact of medical specialist staffing on emergency department patient flow and satisfaction. European journal of emergency medicine. 2019;26(1):47–52. pmid:28704269
- 41. Li S-T, Chiu N-C, Kung W-C, Chen J-CJP, Neonatology. Factors affecting length of stay in the pediatric emergency department. Pediatrics & Neonatology. 2013;54(3):179–87.
- 42. Nelson KA, Boslaugh SE, Hodge DJPec. Risk factors for extremely long length-of-stay among pediatric emergency patients. 2009;25(12):835–40.
- 43. Abbato S, Greer R, Ryan J, Vayne-Bossert P, Good PJJoi, health m. The impact of provision of professional language interpretation on length of stay and readmission rates in an acute care hospital setting. 2019;21(5):965–70.
- 44. Mashao K, Heyns T, White Z. Areas of delay related to prolonged length of stay in an emergency department of an academic hospital in South Africa. African Journal of Emergency Medicine. 2021;11(2):237–41. pmid:33747758
- 45. Sharieff GQ, Burnell L, Cantonis M, Norton V, Tovar J, Roberts K, et al. Improving Emergency Department Time to Provider, Left-Without-Treatment Rates, and Average Length of Stay. The Journal of Emergency Medicine. 2013;45(3):426–32. pmid:23747050