title: Emergency department attendance patterns during Ramadan.
abstract: 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.
  
  
  OBJECTIVE
  Determine if there are differences in tertiary care ed attendance during Ramadan compared to other times of the year.
  
  
  METHODS
  Retrospective, using data from the hospital integrated clinical information system.
  
  
  METHODS
  Tertiary care institution in Riyadh, Saudi Arabia.
  
  
  METHODS
  All ED visits during the Islamic calendar years of 1431-1434 (December 18, 2009-October 13, 2013) were analyzed.
  
  
  METHODS
  Patient volume, acuity, demographics and admission rate variability between Ramadan and other months.
  
  
  RESULTS
  During the study period of 4 years, of 226075 ED patients, 129178 (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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dr. Taimur Butt, Chairman, Department of Emergency Medicine,, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, Riyadh 11211, Saudi Arabia, T: +966-11-4647272, tbutt@kfshrc.edu.sa, ORCID: http://orcid.org/0000-0003-4949-2344.
authors.forename: Taimur
authors.initials: T
authors.lastname: Butt
authors.forename: Hameed Ullah
authors.initials: HU
authors.lastname: Khan
authors.forename: Israr
authors.initials: I
authors.lastname: Ahmed
authors.forename: Abdelmoneim
authors.initials: A
authors.lastname: Eldali
mesh_terms: D000293:Adolescent; D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D007514:Islam; D008297:Male; D062072:Patient Acuity; D010343:Patient Admission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012529:Saudi Arabia; D062606:Tertiary Care Centers; D013997:Time Factors; D055815:Young Adult