Evaluating Factors Associated with Overstay of Patients with Acute Abdomen in Emergency Department of Tertiary Care Hospital

Amna Tariq; Abdus Salam Khan; Arsalan Ahmed Malik; Amna Javed; Badar Islam; Anisa Malik

doi:10.54112/bcsrj.v6i5.2385

Authors

Amna Tariq Department of Emergency Medicine, Shifa International Hospital, Islamabad, Pakistan
Abdus Salam Khan Department of Emergency Medicine, Shifa International Hospital, Islamabad, Pakistan
Arsalan Ahmed Malik Department of Emergency Medicine, Pak Emirates Military Hospital (PEMH), Rawalpindi, Pakistan
Amna Javed Department of Emergency Medicine, Shifa International Hospital, Islamabad, Pakistan
Badar Islam Department of Emergency Medicine, Shifa International Hospital, Islamabad, Pakistan
Anisa Malik Department of Emergency Medicine, Shifa International Hospital, Islamabad, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i5.2385

Keywords:

Acute Abdomen; Emergency Service, Hospital; Length of Stay; Crowding

Abstract

Prolonged emergency department length of stay (EDLOS) may delay definitive management of patients presenting with acute abdomen. Identifying modifiable factors contributing to emergency department overstay may help improve patient flow and timely surgical care. Objective: To evaluate factors associated with emergency department overstay among patients presenting with acute abdomen at a tertiary-care hospital. Methods: This prospective observational analytical study was conducted in the Emergency Department of a tertiary-care hospital from October 2024 to March 2025. A total of 80 consecutive adult patients aged ≥18 years presenting with non-traumatic acute abdomen were enrolled. EDLOS was calculated from registration/triage until physical departure from the emergency department, and overstay was defined as EDLOS >6 hours. Demographic, clinical, diagnostic, and operational factors were recorded. Multivariable binary logistic regression was performed to identify independent predictors of overstay. A p-value <0.05 was considered statistically significant. Results: The mean age of patients was 44.33 ± 14.23 years, and 65.0% were male. Median EDLOS was 5.52 hours (IQR 4.24–7.93). Overall, 38 (47.5%) patients experienced ED overstay >6 hours, while 67 (83.8%) remained in the ED for >4 hours. Laboratory-result delay (52.6% vs 26.2%, p=0.015), inpatient-bed unavailability (55.3% vs 33.3%, p=0.048), ED crowding (68.4% vs 40.5%, p=0.012), and CT requirement (44.7% vs 23.8%, p=0.048) were significantly more frequent among patients with overstay. Independent predictors were laboratory-result delay (aOR 5.47; 95% CI 1.71–17.51), inpatient-bed unavailability (aOR 5.42; 95% CI 1.68–17.52), ED crowding (aOR 5.29; 95% CI 1.69–16.61), and CT requirement (aOR 4.41; 95% CI 1.37–14.23). Conclusion: Nearly half of patients with acute abdomen experienced ED overstay exceeding six hours. Prolonged stay was primarily associated with modifiable operational factors, particularly laboratory delays, inpatient-bed unavailability, ED crowding, and CT requirements. Improving diagnostic turnaround and hospital flow may substantially reduce ED overstay.

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