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Purpose <p>The primary objective is to evaluate associations between emergency department (ED) total length of stay in Alberta and multiple patient-, visit-, and facility-level factors known to contribute to overcrowding and healthcare inefficiencies. This work aims to inform ongoing efforts to optimize ED performance and patient flow and, to our knowledge, is the largest population-based Canadian study examining associations with ED length of stay at multiple levels.</p> Methods <p>We conducted a cross-sectional study of 587,419 ED visits from 14 facilities in Alberta between May 2022 and March 2023 using administrative health data from Alberta Health Services, linked to the National Ambulatory Care Reporting System. Multivariable negative binomial regression was used to examine associations between ED length of stay and patient-, visit-, and facility-level characteristics. Analyses were stratified by patient disposition (admitted, discharged, or other).</p> Results <p>Older age, greater material or social deprivation, and any mode of emergency medical services transport were associated with longer ED length of stay across all disposition categories. Higher hospital inpatient occupancy rate and a greater number of emergency inpatients were associated with increased length of stay, particularly for admitted patients. Higher nurse staffing rates were associated with shorter length of stay, though this association disappeared when accounting for random differences between facilities. Higher patient continuity to physician was associated with a lower length of stay, suggesting a potential benefit of primary care integration.</p> Conclusions <p>ED length of stay is associated with modifiable factors, including hospital capacity constraints, hours worked per nurse, and healthcare access inequities. Addressing hospital occupancy, optimizing staffing, and improving care coordination across the patient trajectory—such as between the ED, inpatient units, and post-discharge services—may enhance ED efficiency and reduce prolonged stays. Our findings align with established frameworks describing ED overcrowding and support targeted, system-level interventions to improve the efficiency of emergency care.</p>

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Factors associated with emergency department length of stay in Alberta: a study of patient-, visit-, and facility-level factors using administrative health data

  • 期刊论文

  • 发表日期：

    2026年1月29日

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  • Eddy Lang,
  • Brian R. Holroyd,
  • Matthew Pietrosanu,
  • Alice P. Y. Chiu,
  • Darren Mazzei,
  • Niloofar Taghizadeh,
  • Shawn Dowling,
  • Terrence McDonald,
  • Michael Sidra

摘要

Purpose

The primary objective is to evaluate associations between emergency department (ED) total length of stay in Alberta and multiple patient-, visit-, and facility-level factors known to contribute to overcrowding and healthcare inefficiencies. This work aims to inform ongoing efforts to optimize ED performance and patient flow and, to our knowledge, is the largest population-based Canadian study examining associations with ED length of stay at multiple levels.

Methods

We conducted a cross-sectional study of 587,419 ED visits from 14 facilities in Alberta between May 2022 and March 2023 using administrative health data from Alberta Health Services, linked to the National Ambulatory Care Reporting System. Multivariable negative binomial regression was used to examine associations between ED length of stay and patient-, visit-, and facility-level characteristics. Analyses were stratified by patient disposition (admitted, discharged, or other).

Results

Older age, greater material or social deprivation, and any mode of emergency medical services transport were associated with longer ED length of stay across all disposition categories. Higher hospital inpatient occupancy rate and a greater number of emergency inpatients were associated with increased length of stay, particularly for admitted patients. Higher nurse staffing rates were associated with shorter length of stay, though this association disappeared when accounting for random differences between facilities. Higher patient continuity to physician was associated with a lower length of stay, suggesting a potential benefit of primary care integration.

Conclusions

ED length of stay is associated with modifiable factors, including hospital capacity constraints, hours worked per nurse, and healthcare access inequities. Addressing hospital occupancy, optimizing staffing, and improving care coordination across the patient trajectory—such as between the ED, inpatient units, and post-discharge services—may enhance ED efficiency and reduce prolonged stays. Our findings align with established frameworks describing ED overcrowding and support targeted, system-level interventions to improve the efficiency of emergency care.