Emergency department attendance patterns during Ramadan

BACKGROUND: Patient 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. OBJECTIVES: Determine if there are differences in tertiary care ED attendance during Ramadan compared to other times of the year. DESIGN: Retrospective, using data from the hospital integrated clinical information system. SETTING: Tertiary care institution in Riyadh, Saudi Arabia. PATIENTS AND METHODS: All ED visits during the Islamic calendar years of 1431–1434 (December 18, 2009–October 13, 2013) were analyzed. MAIN OUTCOME MEASURES: Patient volume, acuity, demographics and admission rate variability between Ramadan and other months. RESULTS: During 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. CONCLUSION: During 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. LIMITATIONS: We 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.