Reasons for Long-Stay Admission in a Typical Overcrowded Emergency of A Teaching Hospital in Tehran Capital City

Ideally, the period of patients admitssion in Emergency Department (ED) should not exceed 6 hours. Prolonged in-hospital course has deleterious effects on ED overcrowding, quality of patient care and patient satisfaction. To evaluate the causes of this problem the current study was conducted in a typical overcrowded ED of a general teaching hospital in Tehran City. In this cross-sectional prospective study, charts from patients held longer than 24 hours, in Imam Hossein Hospital affiliated to Shaheed Beheshti Medical University, were reviewed from October 23rd through November 23rd, 2005. Of 3630 patients, 222 had been held in the ED for more than 24 hours. Reasons for this long-term stay were lack of available bed (68 patients), delayed admission because of involvement of more than one specialty (21 patients), uncertain diagnosis (33 patients) and completion of their treatment course in the ED (52 patients). In addition, Thirty-one left the ED against the medical advice and seventeen were refused to be admitted because they were moribund and medically hopeless. Long-term stay of patients in ED of teaching hospitals is a major problem. The most frequent causes are limitation of inpatient beds, lack of a clear guideline to admit multi-specialty and moribund patient and those with uncertain diagnosis. The following solutions are proposed (1) Creation of a holding unit (2) Delivery of more authority to Emergency Physicians (3) Pre-established rules for admitting controversial patients (4) Active inter-facility transfer