• Logo
  • SBMUJournals

Analysis of the causes of length of stay more than 24 h in the Emergency Department of Tehran’s Imam Hossein Hospital in 2017-2018

Olya Kalantar Hormozi, Hamid Kariman, Hamidreza Hatamabadi




Introduction: In ideal conditions, the maximum length of stay in the Emergency Department (ED) is 6 h. Increased length of stay for patients has harmful effects on the quality of patient care and patient satisfaction and causes overcrowding in the ED. The present study assessed the causes of length of stay more than 24 h in the ED of Imam Hossein Hospital affiliated to Shahid Beheshti University of Medical Sciences in Tehran. Methods: This descriptive study was conducted during a 12-month period, 2017-2018, in the ED of Tehran’s Imam Hossein Hospital. The samples were randomly selected from patients referring to the ED of Imam Hossein Hospital. The data collection tool was a checklist containing information about patients and the actions taken in the ED and the final outcome of the patients. After encoding the collected data, statistical analyzes were done using the SPSS statistical software version 18. Result: Men and women constituted 54.7% and 45.3% of the participants, respectively. The participants below and above 65 years old made up 52.6% and 47.4% of the sample group, respectively. Moreover, 81.3% were admitted to general/internal ED and 18.7% were admitted to trauma/surgery ED. Lack of empty beds in admission ward and intensive care unit (ICU) ward was the main causes of delay in admitting patients. Low patient turnover rate, involvement of multiple therapeutic services, inaccurate diagnosis, delay in lab results, delayed imaging, and the possibility of improvement in condition of the patient in ED were among other notable causes of prolonged stay. Finally, the majority of the patients were hospitalized and referees to other centers had the least frequency. Comparison of trauma and general EDs regarding causes of prolonged length of stay showed that there were no significant differences between the two EDs in prolongation length of stay. Conclusion: According to the results, lack of adequate admission and ICU beds was the main causes of prolonged stay in the ED. Using EMS diversion, increasing the number of admission and ICU beds, referring patients to other centers, setting up emergency care units, and decreasing patient ED overcrowding are suggested as solutions to decrease length of stay in ED.


Emergency service, hospital; length of stay; hospitalization


Pazokian M, Borhani F. Nurses’ Perspectives on Factors Affecting Patient Safety: A Qualitative Study. Evidence Based Care. 2017;7(3):76-81.

Chaou CH, Chen HH, Chang SH, Tang P, Pan SL, Yen AM, 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.

Wang H, Kline JA, Jackson BE, Robinson RD, Sullivan M, Holmes M, et al. The role of patient perception of crowding in the determination of real-time patient satisfaction at Emergency Department. Int J Qual Health Care. 2017;29(5):722-7.

Anneveld M, van der Linden C, Grootendorst D, Galli-Leslie M. Measuring emergency department crowding in an inner city hospital in The Netherlands. Int J Emerg Med. 2013;6(1):21.

Makary MA, Daniel M. Medical error-the third leading cause of death in the US. Bmj. 2016;353:i2139.

Di Somma S, Paladino L, Vaughan L, Lalle I, Magrini L, Magnanti M. Overcrowding in emergency department: an international issue. Intern Emerg Med. 2015;10(2):171-5.

Singer RF, Infante AA, Oppenheimer CC, West CA, Siegel B. The use of and satisfaction with the Emergency Severity Index. J Emerg Nurs. 2012;38(2):120-6.

Chan SS, Cheung NK, Graham CA, Rainer TH. Strategies and solutions to alleviate access block and overcrowding in emergency departments. Hong Kong Med J. 2015;21(4):345-52.

Hefner JL, Wexler R, McAlearney AS. Primary care access barriers as reported by nonurgent emergency department users: implications for the US primary care infrastructure. Am J Med Qual. 2015;30(2):135-40.

Weinick RM, Burns RM, Mehrotra A. Many emergency department visits could be managed at urgent care centers and retail clinics. Health Aff (Millwood). 2010;29(9):1630-6.

Fu KH, Chen YR, Fan JS, Chen YC, Huang HH, How CK, et al. Emergency department critical care unit for critically ill cardiovascular patients: An observation study. J Chin Med Assoc. 2017;80(4):233-44.

Gaieski DF, Agarwal AK, Mikkelsen ME, Drumheller B, Sante SC, Shofer FS, et al. The impact of ED crowding on early interventions and mortality in patients with severe sepsis. The American journal of emergency medicine. 2017;35(7):953-60.

Yarmohammadian MH, Rezaei F, Haghshenas A, Tavakoli N. Overcrowding in emergency departments: A review of strategies to decrease future challenges. J Res Med Sci. 2017;22:23.

Stagg BC, Shah MM, Talwar N, Padovani-Claudio DA, Woodward MA, Stein JD. Factors Affecting Visits to the Emergency Department for Urgent and Nonurgent Ocular Conditions. Ophthalmology. 2017;124(5):720-9.

Georgiou A, Prgomet M, Paoloni R, Creswick N, Hordern A, Walter S, et al. The effect of computerized provider order entry systems on clinical care and work processes in emergency departments: a systematic review of the quantitative literature. Ann Emerg Med. 2013;61(6):644-53.e16.

The Association of average lenght of stay (ALOS) in intensive care units (ICUs) with device-utilization ratio: G. Emori, RN, MS,∗ J. Edwards, MS, R. Gaynes, MD. Centers for Disease Control and Prevention, Atlanta, GA, and the National Nosocomial Infections Surveillance (NNIS) System. American Journal of Infection Control. 1995;23(2):137.

Nasr-Esfahani M, Esmailian M, Nasri M. Causes of prolonged length of stay for patients referred to the emergency department; a cross-sectional study. Iranian Journal of Emergency Medicine. 2014;1(1):45-9.

Analysis of Factors Affecting Length of stay in Public Hospitals in Lorestan Province, Iran. Hakim Health Systems Research Journal. 2010;12(4):27-32.

McCabe JB. Emergency department overcrowding: a national crisis. Acad Med. 2001;76(7):672-4.

McCarthy ML, Zeger SL, Ding R, Levin SR, Desmond JS, Lee J, et al. Crowding delays treatment and lengthens emergency department length of stay, even among high-acuity patients. Ann Emerg Med. 2009;54(4):492-503.e4.

Clarke A. Why are we trying to reduce length of stay? Evaluation of the costs and benefits of reducing time in hospital must start from the objectives that govern change. Qual Health Care. 1996;5(3):172-9.

Fernandes CM, Price A, Christenson JM. Does reduced length of stay decrease the number of emergency department patients who leave without seeing a physician? J Emerg Med. 1997;15(3):397-9.

Imai H, Hosomi J, Nakao H, Tsukino H, Katoh T, Itoh T, et al. Characteristics of psychiatric hospitals associated with length of stay in Japan. Health Policy. 2005;74(2):115-21.

Fry M, MacGregor C. Confidence and impact on clinical decision-making and behaviour in the emergency department. Australas Emerg Nurs J. 2014;17(3):91-7.

Chang BP, Cain D, Mitroff SR. Emergency department crowding associated with differences in CXR interpretations between emergency physicians and radiologists. Am J Emerg Med. 2017;35(5):793-4.

Ay D, Akkas M, Sivri B. Patient population and factors determining length of stay in adult ED of a Turkish University Medical Center. Am J Emerg Med. 2010;28(3):325-30.

Erenler AK, Akbulut S, Guzel M, Cetinkaya H, Karaca A, Turkoz B, et al. Reasons for Overcrowding in the Emergency Department: Experiences and Suggestions of an Education and Research Hospital. Turk J Emerg Med. 2014;14(2):59-63.

Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Ann Emerg Med. 2008;52(2):126-36.

Forster AJ, Stiell I, Wells G, Lee AJ, van Walraven C. The effect of hospital occupancy on emergency department length of stay and patient disposition. Acad Emerg Med. 2003;10(2):127-33.

Kocher KE, Meurer WJ, Desmond JS, Nallamothu BK. Effect of testing and treatment on emergency department length of stay using a national database. Acad Emerg Med. 2012;19(5):525-34.

Brick C, Lowes J, Lovstrom L, Kokotilo A, Villa-Roel C, Lee P, et al. The impact of consultation on length of stay in tertiary care emergency departments. Emerg Med J. 2014;31(2):134-8.

Hatamabady HR. 291: Causes of Length of Stay in a Typical Crowded Emergency Department of a Teaching Hospital in Tehran Capital City. Annals of Emergency Medicine. 2008;52(4):S131.

Movahednia S, Partovishayan Z, Bastani M. A Survey of Timing Indicators of Emergency Department at Firoozgar Hospital: 2012. Journal of Health Administration. 2013;16(51):95-102.

Lu Y, Xu W, Ji J, Feng D, Sourbier C, Yang Y, et al. Alternative splicing of the cell fate determinant Numb in hepatocellular carcinoma. Hepatology. 2015;62(4):1122-31.

Goldfrank L, Henneman PL, Ling LJ, Prescott JE, Rosen C, Sama A, et al. Emergency Center Categorization Standards. Academic Emergency Medicine. 1999;6(6):638-55.

Basir Ghafouri H, Hosseini Kasnavieh M, Sharifi MA, Amini M, Darzi Ramandi A. A Survey of Patients' Length of Stay and Its Effective Predictors in Emergency Departments of TUMS Selected Hospitals. Payavard Salamat. 2017;11(3):18-26.

Kawano T, Nishiyama K, Anan H, Tujimura Y. Direct relationship between aging and overcrowding in the ED, and a calculation formula for demand projection: a cross-sectional study. Emerg Med J. 2014;31(1):19-23.

Shirani F, Jalili M, Asl ESH. Discharge against medical advice from emergency department: results from a tertiary care hospital in Tehran, Iran. Eur J Emerg Med. 2010;17(6):318-21.

Patients' Reasons for Discharge against Medical Advice in University Hospitals of Kashan University of Medical Sciences in 2008. Hakim Health Systems Research Journal. 2010;13(1):33-9.


  • There are currently no refbacks.