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. 2025 Feb 19;15(1):11.
doi: 10.1186/s13561-025-00598-8.

Effects of emergency department length of stay on inpatient utilization and mortality

Kai-Jie Ma #  1 , Yi-Chen Hsu #  2 , Wei-Wen Pan  3 , Ming-Hsien Chou  4 , Wei-Sheng Chung  5 , Jong-Yi Wang  6
Affiliations

Effects of emergency department length of stay on inpatient utilization and mortality

Kai-Jie Ma et al. Health Econ Rev. .

Abstract

Introduction: The annual increase in emergency department (ED) visits in Taiwan has led to overcrowding in major hospitals and extended patient stays in the ED. International studies suggest that prolonged ED stays may influence healthcare costs and clinical outcomes for hospitalized patients. However, such investigations are scarce in Taiwan. This study aims to explore the effects of ED stay duration on inpatient medical utilization and mortality risk.

Methods: This study analyzed data from 42,139 patients at a central Taiwan medical center, using generalized estimating equations (GEE) to evaluate hospital stay duration and costs. Logistic regression assessed mortality risks after hospitalization.

Results: GEE analysis showed longer ED stays led to increased hospital stays: patients with 24-48 h in the ED had an additional 2.27 days (P < 0.001), and those with ≥ 48 h had an additional 3.22 days (P < 0.001). Logistic regression indicated higher mortality risks for patients with 24-48 h (OR = 1.73, P < 0.001) and ≥ 48 h (OR = 2.23, P < 0.001) in the ED compared to those with ≤ 2 h. Conversely, longer ED stays were associated with lower hospitalization costs; patients with ≥ 48 h in the ED incurred $1,211 less in costs compared to those with ≤ 2 h (P < 0.001). Logistic regression revealed that longer ED stays were linked to higher mortality risks, with patients staying 24-48 h in the ED showing an OR of 1.726 (P < 0.001) and those with ≥ 48 h an OR of 2.225 (P < 0.001).

Conclusion: Prolonged ED stays are associated with longer hospital stays, higher mortality risks, and lower hospitalization costs due to resource consumption in the ED. These findings highlight the need for strategies to reduce ED stay durations to improve patient outcomes and optimize resource use.

Keywords: EDLOS; Healthcare quality; Hospital length of stay; Hospitalization costs; Mortality risk.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: In this study, all the research database involving humans were conducted ethically and in accordance with the Declaration of Helsinki. Our study protocols were reviewed and approved by the Institutional Review Board I&II of the Taichung Veterans General Hospital(CE18030B). To protect the patients’ privacy, all personal identification numbers were encrypted by the Taichung Veterans General Hospital before the data were analyzed and released. Therefore, patient informed consent is not required for authorized researchers to access this research database. The researchers of this study are not possible to contact any studied patient for obtaining informed consent. No informed consent form is used in this study. Furthermore, the Institutional Review Board I&II of the Taichung Veterans General Hospital(CE18030B) also specifically waived the requirement of informed consent. Competing interests: The authors declare that there are no conflicts of interest regarding the publication of this manuscript. The research was conducted independently, without any financial or personal relationships that could be viewed as potential conflicts of interest.

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