• Taimur Butt, Hameed Ullah Khan, Israr Ahmed, and Abdelmoneim Eldali.
• 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.
• Ann Saudi Med. 2016 Jul 1; 36 (4): 258-64.

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 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.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.

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