Operational efficiency of emergency units in tertiary hospitals: A delay and waiting time assessment in Ilorin, Nigeria

Abstract

Introduction: Overcrowding in emergency departments and long waiting times adversely affect the quality of care and the well-being of patients. In Nigeria, patients seeking medical attention from the emergency departments in the country’s tertiary hospitals are faced with challenges, but little is known about emergency departments delays in Ilorin, Nigeria. Objectives: To determine delays and waiting time in emergency departments, their associated factors, and how these factors relate to patients’ satisfaction levels in Ilorin, Nigeria. Methods: The study design involves a descriptive, cross-sectional survey among 368 patients/relatives at Kwara State University Teaching Hospital, Ilorin, conducted between January and March 2026. A systematic random sampling method was employed in the recruitment process. Information regarding socio-demographic characteristics, waiting times, factors, and satisfaction levels was obtained through an interviewer-administered, pre-tested questionnaire with time-motion analysis. Data were analyzed using STATA version 17.0 software and associations were tested with Pearson’s chi-square and multivariate logistic regression analysis. Results: The prevalence of delays was two-thirds (66.3%). Time to physician was 106±117 minutes; while 32.61% waited for at least 121 minutes. The longest delay was obtaining diagnostic results (66.85%). Major causes of delays were large patient load (89.14%), communication problems (86.68%), poor triage (84.51%), and shortage of staff (82.34%). Satisfaction rates overall was 79.89%, and efficiency of resources was 90.22%. Female gender, Muslims, Yoruba, and primarily educated patients had better satisfaction levels (p<0.05). Unexpectedly, longer waiting times were significantly associated with high patient satisfaction. Age between 33-46 years and above 75 years, along with males, significantly affected the lower satisfaction rate. The problem of quasi-complete separation made the estimation of some waiting times difficult. Conclusion: Delays in KWASUTH emergency department are high because of system-related factors, but patients’ satisfaction is surprisingly high due to low expectations and the influence of triage. Immediate improvement of triage, diagnostics through digitization, staffing, and communication can improve the situation and bring reality closer to expectations.