Emergency Department Length of Stay Prior to Surgery in Head Injury Patients
DOI:
https://doi.org/10.22219/sm.Vol22.SMUMM1.44440Abstract
Preoperative delays in traumatic brain injury (TBI) significantly increase morbidity and mortality. While general emergency department (ED) crowding is well-documented, specific bottlenecks bridging ED admission to neurosurgical intervention remain underexplored. This study identifies primary determinants prolonging ED length of stay (LOS) for preoperative TBI patients, offering a novel perspective on systemic versus clinical delays. This retrospective cohort study evaluated 102 head injury patients requiring emergency surgery at Dr. Saiful Anwar Hospital from January 2024 to June 2025. Mean ED LOS was 575.5 minutes (≈9.6 hours). Multivariate linear regression showed that prolonged boarding time and extended diagnostic durations were primary predictors of increased LOS (P < 0.05). Conversely, clinical factors like triage priority and staffing ratios did not significantly influence stay duration (P > 0.05). Notably, boarding time was the most dominant factor, accounting for 40.6% of LOS variance (R² = 0.406). These findings indicate that systemic operational inefficiencies in preoperative waiting and diagnostic workflows are more critical drivers of delay than patient acuity. Consequently, hospital management should prioritize optimizing inter-departmental coordination and emergency surgical pathways to improve outcomes for head injury patients.
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Abidin, Z. et al. (2023) Mortalitas Pasien Cedera Kepala Berat Berdasarkan Nilai Mean Arterial Pressure di RSUD Ulin Banjarmasin Januari 2018-Oktober 2021 Mortality Severe Head Injury Patients Based on Mean Arterial Pressure at Ulin Hospital Banjarmasin Since Januari 2018-Oktober 2021.
Ahmed, A.E. et al. (2026) “Clinical and Operational Effects of Emergency Department Crowding: A Systematic Review,” Cureus [Preprint]. Available at: https://doi.org/10.7759/cureus.100560.
American College of Surgeons. Best Practices Guidelines The Management of Traumatic Brain Injury. 2024.
Capizzi, A., Woo, J. and Verduzco-Gutierrez, M. (2020) “Traumatic Brain Injury: An Overview of Epidemiology, Pathophysiology, and Medical Management,” Medical Clinics of North America. W.B. Saunders, pp. 213–238. Available at: https://doi.org/10.1016/j.mcna.2019.11.001.
Emergency Nurses Association (2021) Staffing and productivity in the emergency department: Position statement. Des Plaines, IL: Emergency Nurses Association.
Giri, S. et al. (2022) “Characteristics and outcomes of patients triaged as critically ill in the emergency department of a tertiary care hospital in Bhutan,” International Journal of Emergency Medicine, 15(1). Available at: https://doi.org/10.1186/s12245-022-00468-8.
Haas, R. et al. (2023) “Emergency Department Overcrowding: An Environmental Scan of Contributing Factors and a Summary of Systematic Review Evidence on Interventions,” Canadian Journal of Health Technologies, 3(11). Available at: https://doi.org/10.51731/cjht.2023.786.
Hirani, R. et al. (2025) “Strategies to Reduce Hospital Length of Stay: Evidence and Challenges,” Medicina, 61(5), p. 922. Available at: https://doi.org/10.3390/medicina61050922.
Imowanto, Y. et al. (2025) “FACTORS CORRELATED WITH THE LENGTH OF STAY OF PATIENTS IN THE EMERGENCY DEPARTMENT OF HOSPITAL A, EAST JAVA.” Available at: https://doi.org/10.32539/JKK.V12i1.480.
Janke, A.T., Melnick, E.R. and Venkatesh, A.K. (2022) “Hospital Occupancy and Emergency Department Boarding During the COVID-19 Pandemic,” JAMA Network Open, 5(9), p. e2233964. Available at: https://doi.org/10.1001/jamanetworkopen.2022.33964.
Kementerian Kesehatan Republik Indonesia. (2008) Keputusan Menteri Kesehatan Republik Indonesia Nomor 129/Menkes/SK/II/2008 tentang Standar Pelayanan Minimal Rumah Sakit. Jakarta: Kementerian Kesehatan Republik Indonesia.
Kementerian Kesehatan Republik Indonesia. (2022) Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/MENKES/1600/2022 tentang Pedoman Nasional Pelayanan Kedokteran Tata Laksana Cedera Otak Traumatik. Jakarta: Kementerian Kesehatan Republik Indonesia
Khamis, M.M. et al. (2025) “Effect of Emergency Department Boarding on ICU Length of Stay and In-Hospital Mortality; A Retrospective Cohort Study,” Archives of Academic Emergency Medicine, 13(1). Available at: https://doi.org/10.22037/aaemj.v13i1.2604.
Lauque, D. et al. (2022) “Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis,” Journal of Clinical Medicine, 12(1), p. 32. Available at: https://doi.org/10.3390/jcm12010032.
Lepercq, D. et al. (2023) “Association of Organizational Pathways with the Delay of Emergency Surgery,” JAMA Network Open, 6(4). Available at: https://doi.org/10.1001/jamanetworkopen.2023.8145.
Mehmood, A. et al. (2021) “Delays in emergency department intervention for patients with traumatic brain injury in Uganda,” Trauma Surgery and Acute Care Open, 6(1). Available at: https://doi.org/10.1136/tsaco-2021-000674.
Oskvarek, J.J. et al. (2026) “Emergency Department Crowding in the Modern Era: A Systematic Review (2018–2025),” Clinical and Experimental Emergency Medicine [Preprint]. Available at: https://doi.org/10.15441/ceem.25.172.
Papa, L. and Goldberg, S.A. (2018) ‘Head trauma’, in Walls, R.M. (ed.) Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th edn. Philadelphia: Elsevier, pp. 301–328
Payne, K. et al. (2023) “Factors that contribute to patient length of stay in the emergency department: A time in motion observational study,” Australasian Emergency Care, 26(4), pp. 321–325. Available at: https://doi.org/10.1016/j.auec.2023.04.002.
Samadian, K.D. et al. (2026) “A Cross-Sectional Study on the Impact of Emergency Department Boarding and Crowding on Emergency Department Observation Unit Patient Populations.,” Journal of the American College of Emergency Physicians open, 7(3), p. 100363. Available at: https://doi.org/10.1016/j.acepjo.2026.100363.
Savioli, G. et al. (2022) “Emergency Department Overcrowding: Understanding the Factors to Find Corresponding Solutions,” Journal of Personalized Medicine. MDPI. Available at: https://doi.org/10.3390/jpm12020279.
Shakir, M. et al. (2023) “Factors Delaying the Continuum of Care for the Management of Traumatic Brain Injury in Low- and Middle-Income Countries: A Systematic Review,” World Neurosurgery. Elsevier Inc., pp. 169-193.e3. Available at: https://doi.org/10.1016/j.wneu.2023.09.007.
Shakir, M. et al. (2024) “Temporal Delays in the Management of Traumatic Brain Injury: A Comparative Meta-Analysis of Global Literature,” World Neurosurgery, 188, pp. 185-198.e10. Available at: https://doi.org/10.1016/j.wneu.2024.05.064.
Shikder, Md.K.U., Jahan, A. and Hossain, S. (2023) “Study of factors associated with waiting time for patients undergoing emergency surgery,” Scholars Journal of Applied Medical Sciences, 11(08), pp. 1399–1404. Available at: https://doi.org/10.36347/sjams.2023.v11i08.003.
Vika, T.S.K. et al. (2024) “Knowledge and Attitudes regarding Compliance with the Use of Personal Protective Equipment for Motor Vehicle Test Workers at the Malang Regency Transportation Service,” Saintika Medika, 20(1), pp. 54–64. Available at: https://doi.org/10.22219/sm.vol20.smumm1.32691.
Vrijsen, B.E.L. et al. (2022) “Shorter laboratory turnaround time is associated with shorter emergency department length of stay: a retrospective cohort study,” BMC Emergency Medicine, 22(1), p. 207. Available at: https://doi.org/10.1186/s12873-022-00763-w.
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