Pediatrics emergency department (ED) length of stay (LOS): is the time between ED arrival and ED discharge, admission, or referral to another health facility (1). ED in the hospital is designed for rapid assessment and stabilization with the patient arriving at the hospital in need of immediate care must be accessible 24 hours a day and timeliness is considered an essential component in the quality of ED care (2–4). ED has become an increasingly important unit in the healthcare delivery system and nowadays it is considered the primary doorway for inpatient admissions, discharge, and refers(5, 6).
Prolonged pediatrics ED length of stay are universal problem with differing prevalence across the globe, for instance, 31.3% in Guangzhou, China, 25.7% in north Taiwan, and16.4% in Calabar Southern Nigeria(7–9).Globally in the last 20 years, there is an imbalance between emergency service supply and demand, and annual ED visits increased faster than the growing population, leading to an increase in the number of ED visits resulting in prolonged ED stays(10, 11).
Prolonged pediatrics emergency department LOS is not only associated with reduced quality of care, but also having an impact on socio-economic problems to the parents, hospital occupancy rate, increased constrictions on health service resources, more over it has a significant effect on patient safety by an increased risk of hospital-acquired diseases, morbidity, mortality, and reduce patient satisfaction(6, 12–14).
Different works of literature reported that prolonged ED stay leads to an increased mortality rate by 15%-30% and showed as evidence of poor hospital performance, it also an independent risk factor for pneumonia and each hour increases the risk by approximately 20%,regarding this and many other consequences of prolonged LOS is a global challenge(15–17).Moreover shorter hospital stays reduce unnecessary medical costs and increase bed turnover rate that helps to raise the profit margin of the institution, in addition to reducing total social-related charges (5, 9, 18).
Even though there is variability in the emergency department LOS, several factors contributed to prolonged pediatrics ED length of stay. Of these restricted capacities of the health care system, professional inabilities to correctly triage, lack of decision, utilization of health care such as imaging or laboratory investigations, and increased flow of non-urgent cases to EDs are the most common predisposing factors for prolonged pediatric ED length of stay.(5, 19, 20).
Subsequently, the incidence of communicable and preventable diseases like malaria, diarrheal disease, and pneumonia are high in sub-Saharan African countries and account for 70% of pediatric emergency admissions, this and the rising of the prevalence of non-communicable diseases may increase pediatrics emergency department length of stay (9, 21).
Pediatric emergency subspecialty is not yet well developed in most low and middle-income countries (LMICs) and pediatrics emergency unit care are provided by the general pediatrician and minimal expertise in pediatrics emergency medicine thus, critical gaps in pediatric emergency care exist which may negatively affect patient outcomes and this situation is worse in Ethiopia, where the ratio of pediatricians per population is low and there is no emergency pediatrician (9, 22).
ED overcrowding is an international worry and signifies a global crisis that can influence the quality of service caused by the prolonged length of stay and prolonged LOS also causes overcrowding (9, 23, 24). WHO and FMOH were designing ETAT training and triage standards for health care providers as possible solutions to reduce PED length. However, prolonged pediatrics ED length of stay is still global challenge (14).
There is limited study done in Ethiopia concerning factors associated with LOS in the pediatric ED. Since children are the future of one country and in need of special care have to be emphasized, particularly their health status and providing high-quality care (18). Therefore, this study aimed to assess the pediatric emergency department length of stay and its associated factors among pediatric patients visiting PED of Wolaita Sodo teaching and referral hospital.
Prolonged pediatric ED length of stay is a global challenge that predisposes patients to increased risk of morbidity, mortality, reduced satisfaction, socio-economic burden on the parents, and increased constraints on health facility resources. Prolonged LOS can cause overcrowding and ED overcrowding is an international worry and signifies a global crisis that can influence the quality of service.
ED LOS is a critical component of quality assurance monitoring and is positively associated with patient morbidity, mortality, and reduced patient satisfaction. Children are prone to risks and if they stay longer in the emergency department, the higher the risks are, therefore identification of possible factors for LOS will help to take a targeted intervention to avert prolonged LOS.
Data regarding ED LOS in Ethiopia is scarce. Therefore, the findings of this study will give a snapshot picture for planning to pediatrics ED length of stay, policy-making as well as ED interventions to address problems related to prolonged PED stay. In addition; this study will contribute to the achievement of the Sustainable Development Goal particularly (SDG3). Besides, this study will examine variables like occupation, marital status, prior treatment, and educational status of parents which are not included in other studies, therefore; this study will revise new information on the association of LOS in pediatrics ED.
And, the findings will create awareness in the hospital about the problem and contribute to formulating appropriate interventions to reduce LOS in pediatrics ED. Furthermore, the findings of the study will contribute to battle prolonged LOS.