title: Determinants of Prolonged Length of Stay in the Emergency Department; a Cross-sectional Study.
abstract: BACKGROUND
  Timeliness has been considered as a key domain in quality of emergency department (ED) care and delay in care providing is influential determinants of patient's outcomes. The present study, aimed to evaluate the determinants of prolonged ED length of stay (LOS).
  
  
  METHODS
  In this cross-sectional study, using adopted version of the latest form for external evaluation and accreditation of EDs introduced by Iranian Ministry of Health, determinants of prolonged LOS were evaluated in the ED of an educational Hospital. Using SPSS 11, multivariate binary logistic regression was applied to estimate adjusted odds ratios (OR) for determining factors associated with prolonged LOS.
  
  
  RESULTS
  162 (10.2%) cases with prolonged LOS were detected. Based on univariate analysis, female gender (OR: 1.42, 95% CI: 1.14-1.75, p = 0.001), older age (OR: 1.05, 95% CI: 1.02-1.08, p < 0.0001), admission on evening shifts (OR: 4.0; 95% CI: 1.84-8.68, p < 0.001), triage level I (OR: 1.76, 95% CI: 1.21-2.57, p = 0.003), lack of insurance support (OR: 1.56, 95% CI: 1.12-2.19, p = 0.010), higher number of ordered para-clinical tests (OR: 1.23, 95% CI: 1.11-1.37, p = 0.016), and disposition time > 6 hours (OR, 0.13, p < 0.0001), were significant risk factors of prolonged LOS.
  
  
  CONCLUSIONS
  Older age, lack of insurance support, disposition time > 6 hours due to complexity of patients' complaint, and the necessity of repeated para-clinical measures were the most important reasons for failed provision of timely services. From the view point of ED personnel, a small part of prolonged LOS in ED was concerned with defective ED workflow, while, the most important cause of such delays was the delayed response of the consultancy services.
authors.affiliation: Department of Emergency Medicine, Diabetes research center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Seyed Mohammad
authors.initials: SM
authors.lastname: Hosseininejad
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Hamed
authors.initials: H
authors.lastname: Aminiahidashti
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Seyede Masoume
authors.initials: SM
authors.lastname: Pashaei
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Iraj
authors.initials: I
authors.lastname: Goli Khatir
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Seyed Hosein
authors.initials: SH
authors.lastname: Montazer
authors.affiliation: Department of Emergency Medicine, Orthopedic research center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Farzad
authors.initials: F
authors.lastname: Bozorgi
authors.affiliation: Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
authors.forename: Fahime
authors.initials: F
authors.lastname: Mahmoudi
keywords: Emergency service; Iran; hospital; length of stay; quality of health care; risk factors