Emergency Department length of stay: a mixed-methods study in four Ethiopian public hospitals.

INTRODUCTION

Emergency Department (ED) length of stay is a key performance indicator of healthcare services, as prolonged stays are associated with adverse patient outcomes, increased financial burden, and higher mortality. This study aimed to assess ED length of stay and associated factors among patients in public hospitals in Kellam Wollega, Ethiopia, 2025.

METHODS

An institution-based mixed-methods cross-sectional study was conducted in four public hospitals in the Kellam Wollega Zone, Ethiopia, from April 1-30, 2025. For the quantitative component, 399 adult ED patients were selected using systematic random sampling and interviewed using a structured questionnaire. Clinical and service-related data were supplemented through review of patient charts and ED logs. Descriptive statistics summarized patient characteristics, while multivariable logistic regression identified factors associated with prolonged ED length of stay (p < 0.05). For the qualitative component, 18 healthcare providers were purposively selected for in-depth interviews. Quantitative and qualitative findings were integrated through triangulation to strengthen interpretation.

RESULTS

Some 390 participants completed the questionnaire, yielding a response rate of 97.7%. More than half, 208 (53.3%; 95% CI: 48.2-58.4), experienced prolonged length of stay. Multivariable analysis showed that night-time presentation (AOR = 17.8, p < 0.001), comatose status (AOR = 2.8, p = 0.04), and referral after the ED visit (AOR = 8.0, p = 0.02) were significantly associated with prolonged stays in the ED. Qualitative analysis identified 12 length of stay assessment points, categorized into two themes: patient-related and hospital-related factors.

CONCLUSION

More than half of the patients experienced a prolonged ED length of stay. Factors significantly associated with prolonged stay included time of presentation, triage category, mental status, post ED visit destination, absence of a laboratory test menu, consultation delays, and lack of inpatient beds.