Prolonged emergency department length of stay and fall-risk: A hospital-based observational study

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.