Prolonged emergency department length of stay and fall-risk: A hospital-based observational study
Main Article Content
Abstract
Emergency Department Length of Stay (EDLOS) is an important indicator of emergency care efficiency and may be associated with patient safety outcomes, including fall risk. This study aimed to determine the association between EDLOS and fall-risk classification among patients in the Emergency Department (ED) of Hospital X, Tegal, Indonesia. This quantitative analytical observational study used a cross-sectional approach with prospective data collection from 29 April to 3 May 2025. A total of 100 patients were recruited using accidental (convenience) sampling. EDLOS was measured from ED arrival until discharge, inpatient admission, or transfer to another hospital unit and summarized using median and interquartile range (IQR). For bivariate analysis, EDLOS was categorized using the hospital's operational 4-hour threshold. Fall risk was assessed using the Morse Fall Scale (MFS). Of the participants, 67.0% had normal EDLOS (<4 hours), with a median of 2 hours 30 minutes (IQR: 1 hour 58 minutes–3 hours 58 minutes), while 33.0% had prolonged EDLOS (?4 hours), with a median of 6 hours 03 minutes (IQR: 4 hours 22 minutes–9 hours 15 minutes). Overall, 66.0% had low fall risk, 19.0% high risk, and 15.0% no risk. EDLOS category was significantly associated with fall-risk classification (Pearson's ?² = 200.000, df = 2, p < 0.001; Cramer's V = 0.787, 95% CI: 0.65–0.86). However, this observational finding does not establish causality or an independent effect of EDLOS. Integrating patient-flow management with systematic fall-risk assessment may support patient safety.
Article Details
How to Cite
Irawan, D., Muslim, F. J., & Ni’mah, J. (2026). Prolonged emergency department length of stay and fall-risk: A hospital-based observational study. Journal of Midwifery and Nursing, 8(3), 243-252. https://doi.org/10.35335/jmn.v8i3.7399
References
Burgess, L., Ray-Barruel, G., & Kynoch, K. (2022). Association between emergency department length of stay and patient outcomes: A systematic review. Research in Nursing & Health, 45(1), 59–93. https://doi.org/10.1002/nur.22201
Devia Jaramillo, G., Esmeral Zuluaga, N., & Velandia Avellaneda, V. A. (2025). Effective strategies for reducing patient length of stay in the emergency department: a systematic review and meta-analysis. BMC Emergency Medicine, 25(1). https://doi.org/10.1186/s12873-024-01163-y
Dunne, T. J., Gaboury, I., & Ashe, M. C. (2024). Falls in hospital increase length of stay regardless of degree of harm. Journal of Evaluation in Clinical Practice, 20(4), 396–400. https://doi.org/10.1111/jep.12144
Dwisari, G. A., Sari, K., Pelayanan, M., Di, K., & Sakit, R. (2024). Jurnal ARSI?: Administrasi Rumah Sakit Indonesia Length Of Stay Di Instalasi Gawat Darurat Sebagai Indikator Mutu Pelayanan Kesehatan Di Rumah Sakit X Tahun 2024. 10(3). https://doi.org/10.7454/arsi.v10i3.1186
Eidstø, A., Tuominen, J., Ylä-Mattila, J., Huhtala, H., Palomäki, A., & Koivistoinen, T. (2025). Is a Prolonged Emergency Department Stay a Risk for Patient Safety? JACEP Open, 6(4), 1–8. https://doi.org/10.1016/j.acepjo.2025.100170
Eidstø, A., Ylä-Mattila, J., Tuominen, J., Huhtala, H., Palomäki, A., & Koivistoinen, T. (2024). Emergency department crowding increases 10-day mortality for non-critical patients: a retrospective observational study. Internal and Emergency Medicine, 19(1), 175–181. https://doi.org/10.1007/s11739-023-03392-8
Farimani, R. M., Karim, H., Atashi, A., Tohidinezhad, F., Bahaadini, K., Abu-Hanna, A., & Eslami, S. (2024). Models to predict length of stay in the emergency department: a systematic literature review and appraisal. BMC Emergency Medicine, 24(1), 1–39. https://doi.org/10.1186/s12873-024-00965-4
Fulbrook, P., Miles, S. J., Jordan, F., Hazelwood, S., & Lee, H. Y. (Debbie). (2025). Screening and assessment of falls risk in the emergency department. Australasian Emergency Care, 28(3), 179–185. https://doi.org/10.1016/j.auec.2025.03.003
Ghosh, M., O’Connell, B., Afrifa-Yamoah, E., Kitchen, S., & Coventry, L. (2022). A retrospective cohort study of factors associated with severity of falls in hospital patients. Scientific Reports, 12(1), 1–9. https://doi.org/10.1038/s41598-022-16403-z
Habibah, T., & Dhamanti, I. (2021). Faktor yang Menghambat Pelaporan Insiden Keselamatan Pasien di Rumah Sakit: Literature Review. Jurnal Kesehatan Andalas, 9(4), 449. https://doi.org/10.25077/jka.v9i4.1460
Habibi, M., Juando, J., & Novalinda Ginting, C. (2023). Hubungan Waktu Tunggu Dan Length Of Stay (LOS) Dengan Kepuasan Pasien. JINTAN: Jurnal Ilmu Keperawatan, 3(02), 144–151. https://doi.org/10.51771/jintan.v3i02.505
Harahap. (2022). Analisa Faktor yang Berhubungan dengan Length of Stay Di IGD Rumah Sakit Medan. Keperawatan Universitass Muhammadiyah Jakarta, 1–13.
Lauque, D., Khalemsky, A., Boudi, Z., Östlundh, L., Xu, C., Alsabri, M., Onyeji, C., Cellini, J., Intas, G., Soni, K. D., Junhasavasdikul, D., Cabello, J. J. T., Rathlev, N. K., Liu, S. W., Camargo, C. A., Slagman, A., Christ, M., Singer, A. J., Houze-Cerfon, C. H., … Bellou, A. (2023). Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 12(1). https://doi.org/10.3390/jcm12010032
Muhammad Nur Hidayah, Yanny Trisyani W, & Aan Nuraeni. (2020). Overcrowding Factors in an Emergency Department: A Literature Review. Jurnal Teknologi Kesehatan Borneo, 1(2), 62–69. https://doi.org/10.30602/jtkb.v1i2.18
Muliyadi, M., Azwaldi, A., & Purbasar, P. (2021). Pemenuhan Kebutuhan Rasa Aman Pada Pasien Risiko Jatuh Melalui Asuhan Keperawatan di Pelayanan Rumah Sakit. JKM?: Jurnal Keperawatan Merdeka, 1(2), 293–301. https://doi.org/10.36086/jkm.v1i2.1012
Muslim, F. J. (2025). Factors Influencing Patients at Risk of Falling in the Emergency Department?: A Systematic Literature Review. 1(3), 298–309.
Mutrika, R., & Hutahaean, S. (2022). Penerapan Edukasi Pencegahan Risiko Jatuh Terhadap Peningkatan Pengetahuan Dan Persepsi Pasien Dalam Mencegah Jatuh Di Ruang Rawat Inap Rumah Sakit X. Jurnal Keperawatan Muhammadiyah, 7(4), 107–111. https://doi.org/10.30651/jkm.v7i4.14536
Nhdi, N. Al, Asmari, H. Al, & Thobaity, A. Al. (2021). Investigating indicators of waiting time and length of stay in emergency departments. Open Access Emergency Medicine, 13, 311–318. https://doi.org/10.2147/OAEM.S316366
Novita, N., Ika, I. M., & VIA, S. H. (2023). Analisis Faktor-Faktor yang Mempengaruhi Waktu Tunggu Pasien di Instalasi Gawat Darurat (IGD) Rumah Sakit Umum dr. Zainoel Abidin Banda Aceh. Journal of Medical Science, 4(2), 71–81. https://doi.org/10.55572/jms.v4i2.100
Nurislami, S., Pramesona, B. A., Wintoko, R., & Oktarlina, R. Z. (2023). Faktor-faktor yang Memengaruhi Pelaporan Insiden Keselamatan Pasien: Literature Review. Jurnal Penelitian Perawat Profesional, 5(2), 551–558. https://doi.org/10.37287/jppp.v5i2.1436
Pearce, S., Marchand, T., Shannon, T., Ganshorn, H., & Lang, E. (2023). Emergency department crowding: an overview of reviews describing measures causes, and harms. Internal and Emergency Medicine, 18(4), 1137–1158. https://doi.org/10.1007/s11739-023-03239-2
Purawijaya, H., Satar, Y. P., Andarusito, N., Hadimuljono, E., & Ruahedi, R. (2023). Analisis Faktor-Faktor Yang Mempengaruhi Length Of Stay (LOS) di Instalasi Gawat Darurat Rumah Sakit Hermina Ciputat. Jurnal Manajemen Dan Administrasi Rumah Sakit Indonesia (MARSI), 7(4), 356–368. https://doi.org/10.52643/marsi.v7i4.3565
Saprudin, N., Nengsih, N. A., & Asyiyani, L. N. (2021). Analisis Faktor Yang Berhubungan Dengan Upaya Pencegahan Risiko Jatuh Pada Pasien Di Kabupaten Kuningan. Jurnal Kampus STIKES YPIB Majalengka, 9(2), 180–193. https://doi.org/10.51997/jk.v9i2.138
Schacht, J. A., Mulqueen, S., Mangino, A., Antkowiak, P. S., Burke, R. C., Stenson, B. A., & Chiu, D. T. (2025). Emergency department volume metrics and the association with falls. JACEP Open, 6(2), 100074. https://doi.org/10.1016/j.acepjo.2025.100074
Waszczeniuk, Courtney, W. (2024). Developing a Multifaceted Fall Prevention Strategy in the Emergency Department. 4(1), 1–23.
Wessman, T., Ärnlöv, J., Carlsson, A. C., Ekelund, U., Wändell, P., Melander, O., & Ruge, T. (2022). The association between length of stay in the emergency department and short-term mortality. Internal and Emergency Medicine, 17(1), 233–240. https://doi.org/10.1007/s11739-021-02783-z
Yulianingsih, H., Firman, F., & Meliala, A. (2022). Implementasi Manajemen Lean di Instalasi Gawat Darurat Rumah Sakit Akademik Universitas Gadjah Mada. The Journal of Hospital Accreditation, 4(02), 83–90.
Devia Jaramillo, G., Esmeral Zuluaga, N., & Velandia Avellaneda, V. A. (2025). Effective strategies for reducing patient length of stay in the emergency department: a systematic review and meta-analysis. BMC Emergency Medicine, 25(1). https://doi.org/10.1186/s12873-024-01163-y
Dunne, T. J., Gaboury, I., & Ashe, M. C. (2024). Falls in hospital increase length of stay regardless of degree of harm. Journal of Evaluation in Clinical Practice, 20(4), 396–400. https://doi.org/10.1111/jep.12144
Dwisari, G. A., Sari, K., Pelayanan, M., Di, K., & Sakit, R. (2024). Jurnal ARSI?: Administrasi Rumah Sakit Indonesia Length Of Stay Di Instalasi Gawat Darurat Sebagai Indikator Mutu Pelayanan Kesehatan Di Rumah Sakit X Tahun 2024. 10(3). https://doi.org/10.7454/arsi.v10i3.1186
Eidstø, A., Tuominen, J., Ylä-Mattila, J., Huhtala, H., Palomäki, A., & Koivistoinen, T. (2025). Is a Prolonged Emergency Department Stay a Risk for Patient Safety? JACEP Open, 6(4), 1–8. https://doi.org/10.1016/j.acepjo.2025.100170
Eidstø, A., Ylä-Mattila, J., Tuominen, J., Huhtala, H., Palomäki, A., & Koivistoinen, T. (2024). Emergency department crowding increases 10-day mortality for non-critical patients: a retrospective observational study. Internal and Emergency Medicine, 19(1), 175–181. https://doi.org/10.1007/s11739-023-03392-8
Farimani, R. M., Karim, H., Atashi, A., Tohidinezhad, F., Bahaadini, K., Abu-Hanna, A., & Eslami, S. (2024). Models to predict length of stay in the emergency department: a systematic literature review and appraisal. BMC Emergency Medicine, 24(1), 1–39. https://doi.org/10.1186/s12873-024-00965-4
Fulbrook, P., Miles, S. J., Jordan, F., Hazelwood, S., & Lee, H. Y. (Debbie). (2025). Screening and assessment of falls risk in the emergency department. Australasian Emergency Care, 28(3), 179–185. https://doi.org/10.1016/j.auec.2025.03.003
Ghosh, M., O’Connell, B., Afrifa-Yamoah, E., Kitchen, S., & Coventry, L. (2022). A retrospective cohort study of factors associated with severity of falls in hospital patients. Scientific Reports, 12(1), 1–9. https://doi.org/10.1038/s41598-022-16403-z
Habibah, T., & Dhamanti, I. (2021). Faktor yang Menghambat Pelaporan Insiden Keselamatan Pasien di Rumah Sakit: Literature Review. Jurnal Kesehatan Andalas, 9(4), 449. https://doi.org/10.25077/jka.v9i4.1460
Habibi, M., Juando, J., & Novalinda Ginting, C. (2023). Hubungan Waktu Tunggu Dan Length Of Stay (LOS) Dengan Kepuasan Pasien. JINTAN: Jurnal Ilmu Keperawatan, 3(02), 144–151. https://doi.org/10.51771/jintan.v3i02.505
Harahap. (2022). Analisa Faktor yang Berhubungan dengan Length of Stay Di IGD Rumah Sakit Medan. Keperawatan Universitass Muhammadiyah Jakarta, 1–13.
Lauque, D., Khalemsky, A., Boudi, Z., Östlundh, L., Xu, C., Alsabri, M., Onyeji, C., Cellini, J., Intas, G., Soni, K. D., Junhasavasdikul, D., Cabello, J. J. T., Rathlev, N. K., Liu, S. W., Camargo, C. A., Slagman, A., Christ, M., Singer, A. J., Houze-Cerfon, C. H., … Bellou, A. (2023). Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 12(1). https://doi.org/10.3390/jcm12010032
Muhammad Nur Hidayah, Yanny Trisyani W, & Aan Nuraeni. (2020). Overcrowding Factors in an Emergency Department: A Literature Review. Jurnal Teknologi Kesehatan Borneo, 1(2), 62–69. https://doi.org/10.30602/jtkb.v1i2.18
Muliyadi, M., Azwaldi, A., & Purbasar, P. (2021). Pemenuhan Kebutuhan Rasa Aman Pada Pasien Risiko Jatuh Melalui Asuhan Keperawatan di Pelayanan Rumah Sakit. JKM?: Jurnal Keperawatan Merdeka, 1(2), 293–301. https://doi.org/10.36086/jkm.v1i2.1012
Muslim, F. J. (2025). Factors Influencing Patients at Risk of Falling in the Emergency Department?: A Systematic Literature Review. 1(3), 298–309.
Mutrika, R., & Hutahaean, S. (2022). Penerapan Edukasi Pencegahan Risiko Jatuh Terhadap Peningkatan Pengetahuan Dan Persepsi Pasien Dalam Mencegah Jatuh Di Ruang Rawat Inap Rumah Sakit X. Jurnal Keperawatan Muhammadiyah, 7(4), 107–111. https://doi.org/10.30651/jkm.v7i4.14536
Nhdi, N. Al, Asmari, H. Al, & Thobaity, A. Al. (2021). Investigating indicators of waiting time and length of stay in emergency departments. Open Access Emergency Medicine, 13, 311–318. https://doi.org/10.2147/OAEM.S316366
Novita, N., Ika, I. M., & VIA, S. H. (2023). Analisis Faktor-Faktor yang Mempengaruhi Waktu Tunggu Pasien di Instalasi Gawat Darurat (IGD) Rumah Sakit Umum dr. Zainoel Abidin Banda Aceh. Journal of Medical Science, 4(2), 71–81. https://doi.org/10.55572/jms.v4i2.100
Nurislami, S., Pramesona, B. A., Wintoko, R., & Oktarlina, R. Z. (2023). Faktor-faktor yang Memengaruhi Pelaporan Insiden Keselamatan Pasien: Literature Review. Jurnal Penelitian Perawat Profesional, 5(2), 551–558. https://doi.org/10.37287/jppp.v5i2.1436
Pearce, S., Marchand, T., Shannon, T., Ganshorn, H., & Lang, E. (2023). Emergency department crowding: an overview of reviews describing measures causes, and harms. Internal and Emergency Medicine, 18(4), 1137–1158. https://doi.org/10.1007/s11739-023-03239-2
Purawijaya, H., Satar, Y. P., Andarusito, N., Hadimuljono, E., & Ruahedi, R. (2023). Analisis Faktor-Faktor Yang Mempengaruhi Length Of Stay (LOS) di Instalasi Gawat Darurat Rumah Sakit Hermina Ciputat. Jurnal Manajemen Dan Administrasi Rumah Sakit Indonesia (MARSI), 7(4), 356–368. https://doi.org/10.52643/marsi.v7i4.3565
Saprudin, N., Nengsih, N. A., & Asyiyani, L. N. (2021). Analisis Faktor Yang Berhubungan Dengan Upaya Pencegahan Risiko Jatuh Pada Pasien Di Kabupaten Kuningan. Jurnal Kampus STIKES YPIB Majalengka, 9(2), 180–193. https://doi.org/10.51997/jk.v9i2.138
Schacht, J. A., Mulqueen, S., Mangino, A., Antkowiak, P. S., Burke, R. C., Stenson, B. A., & Chiu, D. T. (2025). Emergency department volume metrics and the association with falls. JACEP Open, 6(2), 100074. https://doi.org/10.1016/j.acepjo.2025.100074
Waszczeniuk, Courtney, W. (2024). Developing a Multifaceted Fall Prevention Strategy in the Emergency Department. 4(1), 1–23.
Wessman, T., Ärnlöv, J., Carlsson, A. C., Ekelund, U., Wändell, P., Melander, O., & Ruge, T. (2022). The association between length of stay in the emergency department and short-term mortality. Internal and Emergency Medicine, 17(1), 233–240. https://doi.org/10.1007/s11739-021-02783-z
Yulianingsih, H., Firman, F., & Meliala, A. (2022). Implementasi Manajemen Lean di Instalasi Gawat Darurat Rumah Sakit Akademik Universitas Gadjah Mada. The Journal of Hospital Accreditation, 4(02), 83–90.
Copyright and Licensing
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.