The Impact of Ramadan on Patient Attendance Patterns in an Emergency Department at a Tertiary Care Center in Beirut, Lebanon

Abstract

Background: Emergency departments (EDs) worldwide experience substantial variability in hourly patient arrivals. The month of Ramadan represents a repetitive annual occurrence, which could be associated with distinct patient arrival patterns compared with other months of the year. Objective: This study examined hourly patient arrival patterns and patient characteristics in an ED in a tertiary care center in Beirut, Lebanon to determine whether there are significant changes in patient attendance patterns during the month of Ramadan. Methods: Data on patients presenting to the ED during the month of Ramadan with those presenting 1 month prior to and 1 month after, between 2012 and 2018, were accounted for in the study. Pearson chi-squared test was used in the bivariate analysis, whereas Student's t-test was used to compare continuous variables. Results: Patient attendance patterns significantly varied between Ramadan and non-Ramadan periods (p < 0.0001). Patient flow dropped starting at 8:00 AM, with the greatest drop between 6:00 PM and 9:00 PM, and increased in the early morning hours between 2:00 AM and 4:00 AM (p < 0.0001). The total number of visits per day significantly decreased in Ramadan compared with non-Ramadan periods (135.6 ± 14.74 vs. 145.5 ± 18.90, p-value < 0.0001), whereas length of stay decreased slightly. Conclusion: We found a drop in daily ED visits during Ramadan, in addition to a distinct pattern of patient arrivals. ED administrators should consider different scheduling arrangements for nurses and physicians during this period in EDs that serve communities where Ramadan is commonly observed. © 2020 Elsevier Inc.