Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis

doi:10.3390/jcm12010032

Review

. 2022 Dec 21;12(1):32.

doi: 10.3390/jcm12010032.

Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis

Dominique Lauque^{1

2}, Anna Khalemsky³, Zoubir Boudi^{4

5}, Linda Östlundh⁶, Chang Xu⁷, Mohammed Alsabri^{2

8}, Churchill Onyeji², Jacqueline Cellini^{9

10}, Geroge Intas¹¹, Kapil Dev Soni¹², Detajin Junhasavasdikul¹³, Jose Javier Trujillano Cabello¹⁴, Niels K Rathlev¹⁵, Shan W Liu¹⁶, Carlos A Camargo Jr¹⁶, Anna Slagman¹⁷, Michael Christ¹⁸, Adam J Singer¹⁹, Charles-Henri Houze-Cerfon¹, Elhadi H Aburawi²⁰, Karim Tazarourte^{21

22}, Lisa Kurland²³, Phillip D Levy²⁴, James H Paxton²⁴, Dionyssios Tsilimingras²⁵, Vijaya Arun Kumar²⁴, David G Schwartz²⁶, Eddy Lang²⁷, David W Bates²⁸, Gabriele Savioli²⁹, Shamai A Grossman², Abdelouahab Bellou^{2

5

24

30}

Affiliations

¹ Department of Emergency Medicine, Purpan Hospital and Toulouse III University, 31300 Toulouse, France.
² Department of Emergency of Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Boston, MA 02115, USA.
³ Management Department, Hadassah Academic College, Jerusalem 91010, Israel.
⁴ Department of Emergency Medicine, Dr Sulaiman Alhabib Hospital, Dubai 2542, United Arab Emirates.
⁵ Global Network on Emergency Medicine, Brookline, MA 02446, USA.
⁶ Örebro University Library, Örebro University, 70182 Örebro, Sweden.
⁷ Ministry of Education, Key Laboratory for Population Health Across-Life Cycle, Anhui Medical University, Hefei 230032, China.
⁸ Department of Pediatrics, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY 11212, USA.
⁹ Countway Library, Harvard Medical School, Boston, MA 02115, USA.
¹⁰ MATHEMATICA, Inc., Princeton, NJ 08540, USA.
¹¹ Department of Critical Care, General Hospital of Nikaia Agios Panteleimon, 18454 Athens, Greece.
¹² Jai Prakash Narayan Apex Trauma Center, Ring Road, New Delhi 110029, India.
¹³ Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
¹⁴ Intensive Care Unit, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain.
¹⁵ Department of Emergency Medicine, University of Massachusetts Medical School, Baystate, Springfield, MA 01199, USA.
¹⁶ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
¹⁷ Division of Emergency and Acute Medicine, Campus Virchow Klinikum and Charité Campus Mitte, Charité Universitätsmedizin, 10117 Berlin, Germany.
¹⁸ Department of Emergency Medicine, 6000 Lucerne, Switzerland.
¹⁹ Department of Emergency Medicine, Renaissance Scholl of Medicine at Stony Brook University, Stony Brook, NY 11794, USA.
²⁰ Department of Pediatrics, College of Medicine and Health Sciences, UAE University, Al Ain P.O. BOX 15551, United Arab Emirates.
²¹ Department of Health Quality, University Hospital, Hospices Civils, 69002 Lyon, France.
²² Department of Emergency Medicine, University Hospital, Hospices Civils, 69002 Lyon, France.
²³ Department of Medical Sciences, Örebro University, 70182 Örebro, Sweden.
²⁴ Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA.
²⁵ Department of Family Medicine & Public Health Sciences, Wayne State University School of Medicine, Detroit, MI 48201, USA.
²⁶ Information Systems Department, Graduate School of Business Administration, Bar-Ilan University, Ramat-Gan 529002, Israel.
²⁷ Department of Emergency Medicine, Emergency Medicine Cumming School of Medicine, University of Calgary, Alberta Health Services, Calgary, AB T2N 1N4, Canada.
²⁸ Department of Healthcare Quality, Brigham and Women Hospital, Harvard Medical School, Boston, MA 02115, USA.
²⁹ Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy.
³⁰ Institute of Sciences in Emergency Medicine, Department of Emergency Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.

PMID: 36614835
PMCID: PMC9821325
DOI: 10.3390/jcm12010032

Review

Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis

Dominique Lauque et al. J Clin Med. 2022.

. 2022 Dec 21;12(1):32.

doi: 10.3390/jcm12010032.

Authors

Affiliations

¹ Department of Emergency Medicine, Purpan Hospital and Toulouse III University, 31300 Toulouse, France.
² Department of Emergency of Medicine, Beth Israel Deaconess Medical Center, Teaching Hospital of Harvard Medical School, Boston, MA 02115, USA.
³ Management Department, Hadassah Academic College, Jerusalem 91010, Israel.
⁴ Department of Emergency Medicine, Dr Sulaiman Alhabib Hospital, Dubai 2542, United Arab Emirates.
⁵ Global Network on Emergency Medicine, Brookline, MA 02446, USA.
⁶ Örebro University Library, Örebro University, 70182 Örebro, Sweden.
⁷ Ministry of Education, Key Laboratory for Population Health Across-Life Cycle, Anhui Medical University, Hefei 230032, China.
⁸ Department of Pediatrics, Brookdale University Hospital and Medical Center, 1 Brookdale Plaza, Brooklyn, NY 11212, USA.
⁹ Countway Library, Harvard Medical School, Boston, MA 02115, USA.
¹⁰ MATHEMATICA, Inc., Princeton, NJ 08540, USA.
¹¹ Department of Critical Care, General Hospital of Nikaia Agios Panteleimon, 18454 Athens, Greece.
¹² Jai Prakash Narayan Apex Trauma Center, Ring Road, New Delhi 110029, India.
¹³ Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
¹⁴ Intensive Care Unit, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain.
¹⁵ Department of Emergency Medicine, University of Massachusetts Medical School, Baystate, Springfield, MA 01199, USA.
¹⁶ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
¹⁷ Division of Emergency and Acute Medicine, Campus Virchow Klinikum and Charité Campus Mitte, Charité Universitätsmedizin, 10117 Berlin, Germany.
¹⁸ Department of Emergency Medicine, 6000 Lucerne, Switzerland.
¹⁹ Department of Emergency Medicine, Renaissance Scholl of Medicine at Stony Brook University, Stony Brook, NY 11794, USA.
²⁰ Department of Pediatrics, College of Medicine and Health Sciences, UAE University, Al Ain P.O. BOX 15551, United Arab Emirates.
²¹ Department of Health Quality, University Hospital, Hospices Civils, 69002 Lyon, France.
²² Department of Emergency Medicine, University Hospital, Hospices Civils, 69002 Lyon, France.
²³ Department of Medical Sciences, Örebro University, 70182 Örebro, Sweden.
²⁴ Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI 48201, USA.
²⁵ Department of Family Medicine & Public Health Sciences, Wayne State University School of Medicine, Detroit, MI 48201, USA.
²⁶ Information Systems Department, Graduate School of Business Administration, Bar-Ilan University, Ramat-Gan 529002, Israel.
²⁷ Department of Emergency Medicine, Emergency Medicine Cumming School of Medicine, University of Calgary, Alberta Health Services, Calgary, AB T2N 1N4, Canada.
²⁸ Department of Healthcare Quality, Brigham and Women Hospital, Harvard Medical School, Boston, MA 02115, USA.
²⁹ Emergency Department, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy.
³⁰ Institute of Sciences in Emergency Medicine, Department of Emergency Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.

PMID: 36614835
PMCID: PMC9821325
DOI: 10.3390/jcm12010032

Abstract

The effect of emergency department (ED) length of stay (EDLOS) on in-hospital mortality (IHM) remains unclear. The aim of this systematic review and meta-analysis was to determine the association between EDLOS and IHM. We searched the PubMed, Medline, Embase, Web of Science, Cochrane Controlled Register of Trials, CINAHL, PsycInfo, and Scopus databases from their inception until 14−15 January 2022. We included studies reporting the association between EDLOS and IHM. A total of 11,337 references were identified, and 52 studies (total of 1,718,518 ED patients) were included in the systematic review and 33 in the meta-analysis. A statistically significant association between EDLOS and IHM was observed for EDLOS over 24 h in patients admitted to an intensive care unit (ICU) (OR = 1.396, 95% confidence interval [CI]: 1.147 to 1.701; p < 0.001, I2 = 0%) and for low EDLOS in non-ICU-admitted patients (OR = 0.583, 95% CI: 0.453 to 0.745; p < 0.001, I2 = 0%). No associations were detected for the other cut-offs. Our findings suggest that there is an association between IHM low EDLOS and EDLOS exceeding 24 h and IHM. Long stays in the ED should not be allowed and special attention should be given to patients admitted after a short stay in the ED.

Keywords: emergency department; in-hospital mortality; intensive care unit; length-of-stay; meta-analysis; systematic review.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Definition of time spent in the emergency department related to each segment of the care process.

**Figure 2**
PRISMA 2020 flow diagram over the record de-duplication screening and selection process.

**Figure 3**
Meta-analysis including studies with the same EDLOS (1.2 h, 1.5 h, 2h, 3 h cut-offs), 4 h, 5 h, 6 h, 8 h, and 24 h cut-offs using the DerSimonian–Laird random effects model). I^2 = I². EDLOS, emergency department length of stay.

See this image and copyright information in PMC

Cited by

Incidence and predictors of neonatal seizures among neonates admitted in Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. A prospective follow-up study.
Alemayehu T, Gebre T, Asmare B, Tafere Y, Kassie B, Tsega TD, Alemu M, Messelu MA. Alemayehu T, et al. Heliyon. 2024 Apr 22;10(9):e29999. doi: 10.1016/j.heliyon.2024.e29999. eCollection 2024 May 15. Heliyon. 2024. PMID: 38707374 Free PMC article.
Shortening emergency department length of stay: Fast track, short-stay unit and acute medical unit.
Huang B. Huang B. Explor Res Clin Soc Pharm. 2025 Jun 19;19:100626. doi: 10.1016/j.rcsop.2025.100626. eCollection 2025 Sep. Explor Res Clin Soc Pharm. 2025. PMID: 40678677 Free PMC article. Review.
Oxygen saturation and acute mountain sickness during repeated altitude exposures simulating high-altitude working schedules.
Waldner NF, Hartmann SE, Muralt L, Lichtblau M, Bader PR, Rawling JM, Lopez I, Ulrich S, Poulin MJ, Bloch KE, Furian M. Waldner NF, et al. Sci Rep. 2025 Apr 15;15(1):12987. doi: 10.1038/s41598-025-97554-7. Sci Rep. 2025. PMID: 40234589 Free PMC article. Clinical Trial.
Extended Focused Assessment with Sonography for Trauma in the Emergency Department: A Comprehensive Review.
Bella FM, Bonfichi A, Esposito C, Zanza C, Bellou A, Sfondrini D, Voza A, Piccioni A, Di Sabatino A, Savioli G. Bella FM, et al. J Clin Med. 2025 May 15;14(10):3457. doi: 10.3390/jcm14103457. J Clin Med. 2025. PMID: 40429451 Free PMC article. Review.
The Role of Telemedicine in Prehospital Traumatic Hand Injury Evaluation.
Avila FR, Carter RE, McLeod CJ, Bruce CJ, Guliyeva G, Torres-Guzman RA, Maita KC, Ho OA, TerKonda SP, Forte AJ. Avila FR, et al. Diagnostics (Basel). 2023 Mar 18;13(6):1165. doi: 10.3390/diagnostics13061165. Diagnostics (Basel). 2023. PMID: 36980474 Free PMC article. Review.

See all "Cited by" articles

References

1. Mohr N.M., Wessman B.T., Bassin B., Elie-Turenne M.C., Ellender T., Emlet L.L., Ginsberg Z., Gunnerson K., Jones K.M., Kram B., et al. Boarding of critically III patients in the emergency department. J. Am. Coll. Emerg. Physicians Open. 2020;1:423–431. doi: 10.1002/emp2.12107. - DOI - PMC - PubMed
1. Australasian College for Emergency Medicine: Policy on Standard Terminology (Revised 2014) [(accessed on 19 June 2017)]. Available online: https://acem.org.au.
1. Rose L., Scales D.C., Atzema C., Burns K.E., Gray S., Doing C., Kiss A., Rubenfeld G., Lee J.S. Emergency department length of stay for critical care admissions. A population-based study. Ann. Am. Thorac. Soc. 2016;13:1324–1332. doi: 10.1513/AnnalsATS.201511-773OC. - DOI - PubMed
1. Canadian Association of Emergency Physicians, CAEP Position Statement on Emergency Department Overcrowding. 2009. [(accessed on 1 January 2020)]. Available online: http://caep.ca/sites/caep.ca/files/caep/files/edoc_position_statement_bo....
1. Horwitz L.I., Green J., Bradley E.H. US Emergency Department performance on wait time and length of visit. Ann. Emerg. Med. 2010;55:133–141.e5. doi: 10.1016/j.annemergmed.2009.07.023. - DOI - PMC - PubMed

Publication types

Actions

LinkOut - more resources

Full Text Sources

[1] Mohr N.M., Wessman B.T., Bassin B., Elie-Turenne M.C., Ellender T., Emlet L.L., Ginsberg Z., Gunnerson K., Jones K.M., Kram B., et al. Boarding of critically III patients in the emergency department. J. Am. Coll. Emerg. Physicians Open. 2020;1:423–431. doi: 10.1002/emp2.12107. - DOI - PMC - PubMed

[2] Mohr N.M., Wessman B.T., Bassin B., Elie-Turenne M.C., Ellender T., Emlet L.L., Ginsberg Z., Gunnerson K., Jones K.M., Kram B., et al. Boarding of critically III patients in the emergency department. J. Am. Coll. Emerg. Physicians Open. 2020;1:423–431. doi: 10.1002/emp2.12107. - DOI - PMC - PubMed

[3] Australasian College for Emergency Medicine: Policy on Standard Terminology (Revised 2014) [(accessed on 19 June 2017)]. Available online: https://acem.org.au.

[4] Australasian College for Emergency Medicine: Policy on Standard Terminology (Revised 2014) [(accessed on 19 June 2017)]. Available online: https://acem.org.au.

[5] Rose L., Scales D.C., Atzema C., Burns K.E., Gray S., Doing C., Kiss A., Rubenfeld G., Lee J.S. Emergency department length of stay for critical care admissions. A population-based study. Ann. Am. Thorac. Soc. 2016;13:1324–1332. doi: 10.1513/AnnalsATS.201511-773OC. - DOI - PubMed

[6] Rose L., Scales D.C., Atzema C., Burns K.E., Gray S., Doing C., Kiss A., Rubenfeld G., Lee J.S. Emergency department length of stay for critical care admissions. A population-based study. Ann. Am. Thorac. Soc. 2016;13:1324–1332. doi: 10.1513/AnnalsATS.201511-773OC. - DOI - PubMed

[7] Canadian Association of Emergency Physicians, CAEP Position Statement on Emergency Department Overcrowding. 2009. [(accessed on 1 January 2020)]. Available online: http://caep.ca/sites/caep.ca/files/caep/files/edoc_position_statement_bo....

[8] Canadian Association of Emergency Physicians, CAEP Position Statement on Emergency Department Overcrowding. 2009. [(accessed on 1 January 2020)]. Available online: http://caep.ca/sites/caep.ca/files/caep/files/edoc_position_statement_bo....

[9] Horwitz L.I., Green J., Bradley E.H. US Emergency Department performance on wait time and length of visit. Ann. Emerg. Med. 2010;55:133–141.e5. doi: 10.1016/j.annemergmed.2009.07.023. - DOI - PMC - PubMed

[10] Horwitz L.I., Green J., Bradley E.H. US Emergency Department performance on wait time and length of visit. Ann. Emerg. Med. 2010;55:133–141.e5. doi: 10.1016/j.annemergmed.2009.07.023. - DOI - PMC - PubMed

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis

Affiliations

Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

LinkOut - more resources

Full Text Sources

Abstract

Conflict of interest statement

Figures

Similar articles

Cited by

References

Publication types

Related information

LinkOut - more resources

Full Text Sources