The impact of chronic conditions on emergency department length of stay

Background: Emergency Departments (EDs) are increasingly managing elderly patients with chronic diseases and complex comorbidities. While the association between chronic conditions and poor clinical outcomes is well established, their impact on ED operational performance, particularly on length of stay (LOS), remains underexplored. Methods: We conducted a retrospective, single-center observational study at Merano Hospital (Italy), analyzing a random sample of adults ED visits in 2023. Patients were classified as having chronic conditions if they had >= 2 pre-existing chronic conditions. Demographic, clinical, and access-related variables were extracted from electronic health records. The primary outcome was ED LOS, defined as the time from registration to ED chart closure, excluding boarding time. Univariate and multivariable logistic regression analyses were used to identify predictors of prolonged LOS (>= 75th percentile). Results: Among 4172 patients, 12.9% were classified as having chronic conditions. These patients were significantly older and more likely to present with prolonged symptoms and acute exacerbations of chronic illnesses. Median ED LOS was significantly longer among chronic patients (127.6 vs. 97.0 min, p < 0.001). Chronic status emerged as an independent predictor of prolonged LOS (OR 1.537, 95% CI 1.223-1.932). In patients with low triage priority, the presence of chronic conditions was associated with a 54-min increase in LOS and a 52% increase in log-transformed LOS (p < 0.001). Conclusions: Chronic conditions are associated with significantly longer ED management times, irrespective of clinical urgency. These findings highlight the need for targeted strategies to enhance care integration and alleviate the burden on ED services.