• Maria Fatimah Fouk Universitas Brawijaya
  • Titin Andri Wihastuti
  • Dewi Kartikawati Ningsih




Delay treatment time, Length of stay, patients admission


Overcrowding patients is a crisis  problem in hospital and plays a significant role as a front line in hospital which performing good and bad quality of care. Length of Stay (LOS) patients admission measurement indicator toward service process and patients density marker. Length of stay has important essence in reviewing process because helping to identify the cause of action delay and elongated LOS. EDLOS is influenced by input and trough put factor. Input factor: age, coming time, main complaint and co-morbidity. Trough put factor: triage level, door to doctor, the quickness in laboratory check, the quickness in specialist consultation and patients transfer to nursing room, staffing. This study is aimed to analyze the correlation of causing factor on action delay with LOS patients admission  in Prof. Dr. W. Z. Johannes Public Hospital Kupang. This study uses cross sectional approach and quota sampling by the number of 200 patients and nurses also doctors. Data was collected by observation sheet. Result of this study shows that there are significant correlation between co-morbidity with LOS patients admission (p value = 0,001 and r = - 0,227), between the quickness of specialist consultation with LOS patients admission (p value = 0,001 and r = 0,238) and between patients transfer to nursing room LOS patients admission (p value = 0,000 and r = 0,699). Based on the result of linear regression test, it is concluded that factor that has very close correlation with LOS patients admission patients transfer to nursing room (p value < 0,001, regression coefficient 0,015 and correlation coefficient 0,774). Conclusion: co-morbidity, specialist consultation and patients transfer to nursing room is LOS patients admission predictor. Developing centralized bed control dan transporter is mandatory for decrease overcrowding and LOS patients admission in emergency department.


  • ACEP Task Force Report on Boarding: Emergency Department Crowding: High-impact Solutions. American College of Emergency Physicians. 2008.
  • Affleck, A., Parks, P., Drummond, A., Rowe, B. H., & Ovens, H. J. 2013. Emergency department overcrowding and access block. Cjem, 15 (06): 359-370.
  • Asplin, B. R. 2006. Measuring crowding: time for a paradigm shift. Academic Emergency Medicine, 13 ( 4): 459-461.
  • Asaro, P. V., Lewis, L. M., & Boxerman, S. B. 2007. The impact of input and output factors on emergency department throughput. Academic Emergency Medicine, 14 (3): 235-242.
  • Barbee, G., Berry-Cabán, C., Daymude, M., Oliver, J. and Gay, S., 2010. The effect of provider level triage in a military treatment facility emergency department. Australasian Journal of Paramedicine, 8 (4).
  • Bernstein, S. L., Aronsky, D., Duseja, R., Epstein, S., Handel, D., Hwang, U., ... & Schafermeyer, R. 2009. The effect of emergency department crowding on clinically oriented outcomes. Academic Emergency Medicine, 16 (1): 1-10.
  • Boyle, A., Beniuk, K., Higginson, I., & Atkinson, P. 2012. Emergency department crowding: time for interventions and policy evaluations. Emergency medicine international, 2012.
  • Brick, C., Lowes, J., Lovstrom, L., Kokotilo, A., Villa-Roel, C., Lee, P., ... & Rowe, B. H. 2014. The impact of consultation on length of stay in tertiary care emergency departments. Emergency Medicine Journal, 31 (2): 134-138
  • .
  • Brouns, S.H., Stassen, P.M., Lambooij, S.L., Dieleman, J., Vanderfeesten, I.T. and Haak, H.R., 2015. Organisational Factors Induce Prolonged Emergency Department Length of Stay in Elderly Patients–A Retrospective Cohort Study. PloS one, 10(8), p.e0135066.
  • Buchari, H., Albazli, K., Almaslmani, S., Attiah, A., Bukhary, E., Najjar, F., & Al-Maghrabi, H. 2014. Analysis of Waiting Time in Emergency Department of Al-Noor Specialist Hospital, Makkah, Saudi Arabia. Open Journal of Emergency Medicine, 2 (04): 67.
  • CDC. (2010). National health statistics reports number 26.Accessed November 2, 2010 from http://www.cdc.gov/nchs/data/nhsr/nhsr026.
  • Chalfin, D. B., Trzeciak, S., Likourezos, A., Baumann, B. M., Dellinger, R. P., & delay ED study group. 2007. Impact of delayed transfer of critically ill patients from the emergency department to the intensive care unit*. Critical care medicine, 35 (6): 1477-1483.
  • Depkes RI, K.K., 2011. Standar Pelayanan Keperawatan GAwat Darurat di Rumah Sakit.Jakarta: Perpustakaan Depkes RI
  • Dormann, H., Diesch, K., Ganslandt, T., & Hahn, E. G. 2010. Numerical parameters and quality indicators in a medical emergency department. Dtsch Arztebl Int, 107 (15): 261-267.
  • Fee, C., Burstin, H., Maselli, J. H., & Hsia, R. Y. 2012. Association of emergency department length of stay with safety-net status. JAMA, 307 (5: 476-482.
  • Gentile, S., Vignally, P., Durand, A. C., Gainotti, S., Sambuc, R., & Gerbeaux, P. 2010. Nonurgent patients in the emergency department? A French formula to prevent misuse. BMC health services research, 10 (1): 1.
  • Gill, D., Galvin, S., Ponsford, M., Bruce, D., Reicher, J., Preston, L., & Stoneham, S. 2012. Laboratory sample turnaround times: do they cause delays in the ED?. Journal of evaluation in clinical practice, 18 (1): 121-127.
  • Guttmann, A., Schull, M. J., Vermeulen, M. J., & Stukel, T. A. 2011. Association between waiting times and short term mortality and hospital admission after departure from emergency department: population based cohort study from Ontario, Canada. Bmj, 342, d2983.
  • Handel, D. A., Hilton, J. A., Ward, M. J., Rabin, E., Zwemer Jr, F. L., & Pines, J. M. 2010. Emergency department throughput, crowding, and financial outcomes for hospitals. Academic Emergency Medicine, 17 (8): 840-847.
  • Hoot, N. R., & Aronsky, D. 2008. Systematic review of emergency department crowding: causes, effects, and solutions. Annals of emergency medicine, 52 (2): 126-136.
  • Huang, Q., Thind, A., Dreyer, J.F. and Zaric, G.S., 2010. The impact of delays to admission from the emergency department on inpatient outcomes. BMC emergency medicine, 10(1), p.1.
  • Hawkins, R. C. 2007. Laboratory turnaround time. Clinical Biochemist Reviews, 28 (4): 179.
  • Jalili, M., Shalileh, K., Mojtahed, A., Mojtahed, M., & Moradi-Lakeh, M. 2012. Identifying causes of laboratory turnaround time delay in the emergency department. Archives of Iranian medicine, 15 (12): 759.
  • Johnson, K. D. 2011. Patients vital signs and the length of time between the monitoring of vital signs during times of emergency department crowding. (Doctoral dissertation, Case Western Reserve University).
  • Joint Commission, 2013. The “Patient Flow Standard†and the 4-hour recommendation. Joint Commission Perspectives, 33 (6): pp.1-4.
  • Karaca, Z., Wong, H. S., & Mutter, R. L. 2012. Duration of patients’ visits to the hospital emergency department. BMC emergency medicine, 12 (1): 1.
  • Kondo, Y., Toyoshima, H., Yatsuya, H., Hirose, K., Morikawa, Y., Ikedo, N., Masui, T. and Tamakoshi, K., 2007. Risk factors for first acute myocardial infarction attack assessed by cardiovascular disease registry data in Aichi Prefecture. Nagoya journal of medical science, 69(3-4), pp.139-147.
  • Krall, S.P., Cornelius, A.P. and Addison, J.B., 2014. Hospital factors impact variation in emergency department length of stay more than physician factors. Western Journal of Emergency Medicine, 15 (2): p.158.
  • Lee, R. S., Woods, R., Bullard, M., Holroyd, B. R., & Rowe, B. H. 2008. Consultations in the emergency department: a systematic review of the literature. Emergency Medicine Journal, 25 (1): 4-9.
  • Liew D, Liew D, Kennedy MP. Emergency department length of stay independently predicts excess inpatient length of stay. Med J Aust 2003; 179:524-526.
  • Lucas, R., Farley, H., Twanmoh, J., Urumov, A., Olsen, N., Evans, B., & Kabiri, H. 2009. Emergency department patient flow: the influence of hospital census variables on emergency department length of stay. Academic Emergency Medicine, 16 (7): 597-602.
  • McCarthy, M. L., Zeger, S. L., Ding, R., Levin, S. R., Desmond, J. S., Lee, J., & Aronsky, D. 2009. Crowding delays treatment and lengthens emergency department length of stay, even among high-acuity patients. Annals of emergency medicine, 54 (4): 492-503.
  • Mason, S., Weber, E. J., Coster, J., Freeman, J., & Locker, T. 2012. Time patients spend in the emergency department: England's 4-hour rule—a case of hitting the target but missing the point?. Annals of emergency medicine, 59 (5): 341-349.
  • Nash, K., Zachariah, B., Nitschmann, J., &Psencik, B. (2007).Evaluation of the fast track unit of a university emergency department. Journal of Emergency Nursing, 33(1), 14-20.
  • Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., & Zelevinsky, K. 2002. Nurse-staffing levels and the quality of care in hospitals. New England Journal of Medicine, 346 (22): 1715-1722.
  • Ningsih, D. K. 2015. Overcrowding patient and improving emergency patient flow in emergency department: a literature review. Jurnal Ilmu Keperawatan, 3 (2):150.
  • Nippak, P. M., Isaac, W. W., Ikeda-Douglas, C. J., Marion, A. M., & Vanden-Broek, M. 2014. Is there a relation between emergency department and inpatient lengths of stay?. Can J Rural Med, 19 (1).
  • Noorani, M.M., Khaliq, M.F., Shoaib, M., Sheikh, A., Moazzum, W. and Ali, S.A., 2014. Time intervals and associated factors of emergency treatment: first insight into Pakistani system. International archives of medicine, 7 (1): p.1.
  • Parker, B. T., & Marco, C. 2014. Emergency department length of stay: accuracy of patient estimates. Western Journal of Emergency Medicine, 15 (2)
  • Qureshi, N.A., 2010. Triage systems: a review of the literature with reference to Saudi Arabia/Systèmes de triage: revue de la littérature et référence à l'Arabie saoudite. Eastern Mediterranean Health Journal, 16 (6): p.690.
  • Rathlev, N. K., Chessare, J., Olshaker, J., Obendorfer, D., Mehta, S. D., Rothenhaus, T., ... & Lewis, K. 2007. Time series analysis of variables associated with daily mean emergency department length of stay. Annals of emergency medicine, 49 (3): 265-271.
  • Raj, K., Baker, K., Brierley, S., & Murray, D. (2006). National Emergency Department Overcrowding Study tool is not useful in an Australian emergency department. Emergency Medicine Australasia, 18(3), 282-288.
  • Reiter, M. 2015. Door to doctor times (in menute): 11 Benchmarks That Should Matter to EPs.Monthly. Telemedisine magazine. http://epmonthly.com/article/11-benchmarks-that-should-matter-to-eps/ diakses tgl 5 Mei 2016
  • Richardson, D. B. 2006. Increase in patient mortality at 10 days associated with emergency department overcrowding. Medical journal of Australia, 184 (5): 213.
  • Rooney, K. D., & Schilling, U. M. 2014. Point-of-care testing in the overcrowded emergency department–can it make a difference?. Critical Care, 18(6): 1-7.
  • Schneider, S., F. Zwemer, A. Doniger, R. Dick, T. Czapranski and E. Davis. 2001. “Rochester, New York: A Decade of Emergency Department Overcrowding.†Academic Emergency Medicine 8(11): 1044–50.
  • Schull, M.J., Kiss, A. and Szalai, J.P., 2007. The effect of low-complexity patients on emergency department waiting times. Annals of emergency medicine, 49 (3): pp.257-264.
  • Singer, A. J., Thode Jr, H. C., Viccellio, P., & Pines, J. M. 2011. The association between length of emergency department boarding and mortality. Academic Emergency Medicine, 18 (12): 1324-1329.
  • Singer, Adam J., et al.2008. "Introduction of a stat laboratory reduces emergency department length of stay." Academic Emergency Medicine 15 (4): 324-328.
  • Sun, Y., Heng, B. H., Tay, S. Y., & Seow, E. 2011. Predicting hospital admissions at emergency department triage using routine administrative data. Academic Emergency Medicine, 18 (8): 844-850.
  • Tashkandy, M. A., Gazzaz, Z. J., Farooq, M. U., & Dhafar, K. O. 2008. Reasons for delay in inpatient admission at an emergency department. J Ayub Med Coll Abbottabad, 20 (1): 38-42.
  • Trzeciak, S., & Rivers, E. P. 200). Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emergency medicine journal, 20 (5): 402-405.
  • Twigg, D., Duffield, C., Bremner, A., Rapley, P., & Finn, J. 2012. Impact of skill mix variations on patient outcomes following implementation of nursing hours per patient day staffing: a retrospective study. Journal of advanced nursing, 68 (12): 2710-2718.
  • van der Veen, D., Heringhaus, C., & de Groot, B. 2016. Appropriateness, Reasons and Independent Predictors of Consultations in the Emergency Department (ED) of a Dutch Tertiary Care Center: A Prospective Cohort Study. PloS one, 11 (2): e0149079.
  • Wibulpolprasert, A., Sittichanbuncha, Y., Sricharoen, P., Borwornsrisuk, S. and Sawanyawisuth, K., 2014. Factors Associated with Overcrowded Emergency Rooms in Thailand: A Medical School Setting. Emergency medicine international, 2014..
  • Welch, S. J., Asplin, B. R., Stone-Griffith, S., Davidson, S. J., Augustine, J., Schuur, J., & Alliance, E. D. B. 2011. Emergency department operational metrics, measures and definitions: results of the second performance measures and benchmarking summit. Annals of emergency medicine, 58 (1): 33-40.
  • Welch, S.J., Stoneâ€Griffith, S., Asplin, B., Davidson, S.J., Augustine, J. and Schuur, J.D., 2011. Emergency department operations dictionary: results of the second performance measures and benchmarking summit. Academic Emergency Medicine, 18 (5): pp.539-544.
  • Woods, R. A., Lee, R., Ospina, M. B., Blitz, S., Lari, H., Bullard, M. J., & Rowe, B. H. 2008. Consultation outcomes in the emergency department: exploring rates and complexity. Cjem, 10(01), 25-31.
  • Yoon, P., Steiner, I., & Reinhardt, G. 2003. Analysis of factors influencing length of stay in the emergency department. Cjem, 5 (03): 155-161.
  • Zarea, K., Negarandeh, R., Dehghanâ€Nayeri, N., & Rezaeiâ€Adaryani, M. 2009. Nursing staff shortages and job satisfaction in Iran: Issues and challenges. Nursing & health sciences, 11 (3): 326-331.




How to Cite

Fouk, M. F., Wihastuti, T. A., & Ningsih, D. K. (2017). FACTOR ANAYSIS THE CAUSE OF DELAYED INTERVENTION WITH LENGTH OF STAY PATIENTS ADMISSION IN EMERGENCY DEPARTMENT OF PROF. DR. W.Z. JOHANNES GENERAL HOSPITAL KUPANG. Journal of Nursing Science Update (JNSU), 5(2), pp. 172–195. https://doi.org/10.21776/ub.jik.2017.005.02.7




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