title: The effect of new emergency program on patient length of stay in a teaching hospital emergency department of Tehran.
abstract: OBJECTIVE
  Ideally, the period of patients admitting in the Emergency Department (ED) should not exceed 6 hours. Prolonged of the patients admitting time affects the ED overcrowding, quality of patient care and patient satisfaction. To evaluate the efficacy of new programs and suggest new strategies to reduce the overcrowding in a typical overcrowded ED of general teaching hospital in Tehran city.
  
  
  METHODS
  In this descriptive case study, charts of patients held over 24 hours, in Imam Hossein Hospital affiliated to the Shaheed Beheshti Medical University, were reviewed from April 21(rd) on August 23(rd), 2008.
  
  
  RESULTS
  Of 15,477 patients, 151 (1%) have been held in the ED over 24 hours. Reasons for this long-stay included:lack of available bed in Intensive Care Unit (ICU) (125 patients), lack of available bed in related wards (18 patients), poor final decision - making by physician (eight patient).
  
  
  CONCLUSIONS
  Long-term stay of patients in ED of teaching hospital is a major problem. The most frequent cause is a limitation of inpatient beds. The long stay time had not been affected by paraclinic procedures, multispecialities involvement or the lack of obvious diagnosis. The following solution is proposed: (1) creation of a holding unit, (2) active inter-facility transfer and (3) governing admittance of patients who need ICU care to related wards.
authors.affiliation: Department of Emergency Medicine, Mazandaran University of Medical Science, Sari, Iran.
authors.forename: Z
authors.initials: Z
authors.lastname: Talleshi
authors.affiliation: Department of Emergency Medicine, Mazandaran University of Medical Science, Sari, Iran.
authors.forename: S M
authors.initials: SM
authors.lastname: Hosseininejad
authors.affiliation: Department of Emergency Medicine, Mazandaran University of Medical Science, Sari, Iran.
authors.forename: Goli
authors.initials: G
authors.lastname: Khatir
authors.affiliation: Department of Nursing, Nasibeh Nursing and Midwifery, Mazandaran University of Medical Science, Sari, Iran.
authors.forename: F
authors.initials: F
authors.lastname: Bozorghi
authors.affiliation: Education Development Center, Mazandaran University of Medical Science, Sari, Iran.
authors.forename: A M Heidari
authors.initials: AM
authors.lastname: Gorji
authors.affiliation: Department of Nursing and Midwifery, Traditional and Complementary Medicine Research Center, Mazandaran University of Medical Science, Sari, Iran.
authors.forename: M A Heidari
authors.initials: MA
authors.lastname: Gorji
keywords: ED; Imam Hossein hospital; Tehran; over-crowded