Emergency department attendance patterns during Ramadan

Abstract

BACKGROUNDPatient attendance in the emergency department (ED) is inherently variable and unpredictable. Resources might be better allocated if use of the ER could be predicted. During the month of fasting (Ramadan), healthy adult Muslims do not eat or drink from dawn to sunset and in the Middle East, social activities occur mostly during night. There is no published data that has reported changes in local ED attendance pattern during Ramadan.OBJECTIVESDetermine if there are differences in tertiary care ED attendance during Ramadan compared to other times of the year.DESIGNRetrospective, using data from the hospital integrated clinical information system.SETTINGTertiary care institution in Riyadh, Saudi Arabia.PATIENTS AND METHODSAll ED visits during the Islamic calendar years of 1431–1434 (December 18, 2009–October 13, 2013) were analyzed.MAIN OUTCOME MEASURESPatient volume, acuity, demographics and admission rate variability between Ramadan and other months.RESULTSDuring the study period of 4 years, of 226 075 ED patients, 129 178 (57.14%) patients were seen during the day shift (07:00 to 18:59). During Ramadan, 10 293 (60%) patients presented during the night shift compared with the day shift (P<.0001). This trend was seen consistently with no statistically significant differences in admissions 7%, triage acuity or when compared with other months.CONCLUSIONDuring Ramadan, ED attendance changes as more patients present during the night shift. In Saudi Arabia and possibly other Muslim countries, appropriate resources should be allocated during Ramadan to manage the nocturnal ED patient surge.LIMITATIONSWe believe that the majority of our patients fast, but it is not known how many ED patients were actually fasting during the study period. This study was conducted in a tertiary care hospital and the patient population presenting to our ED is predominantly Muslim; therefore, the results may not be generalized to populations that are not predominantly Muslim.

Analysis of Patients Who Present to Emergency Departments During Ramadan

“…In another study, 40% of patients presented to emergency departments between 23:00 and 8:00 hours [10]. Butt et al showed that during Ramadan, approximately 60% of patients were presented to emergency departments during the night [2]. Another study reported most patients presented to emergency departments between 16:00 and 20:00 hours [6].…”

“…Moreover, these studies did not assess the fasting status of patients presenting to emergency departments. The presented study assessed the fasting status and emergency services required by patients during Ramadan more accurately and objectively than previous studies [1,2,[4][5][6][7]. One study assessed 40000 Muslim subjects, of which 93% fasted during Ramadan [8,9].…”

“…Therefore, the fasting period can last for 18 hours, especially during the summer months. The Islamic religion exempts patients with chronic illnesses, children, elderly individuals, psychiatric patients, healthy passengers, pregnant women, and nursing mothers from fasting [2,3].…”

“…Prediction of the number of patients visiting emergency departments and characteristics of these patients is difficult and may vary according to seasons, local events, school terms, increase in the number of visitors from the outside city, or special periods such as Ramadan [2]. To maintain the quality of patient care, to ensure effective patient flow, and to decrease the length of hospital stay, it is important to maintain a balance between available healthcare resources and patient demand.…”

“…To maintain the quality of patient care, to ensure effective patient flow, and to decrease the length of hospital stay, it is important to maintain a balance between available healthcare resources and patient demand. Health administrators should closely follow changes in social dynamics and make preparations accordingly [2]. In communities with large Muslim populations, the month of Ramadan is associated with important changes in the presentation of patients to hospitals, especially emergency departments.…”