Causes of Length ofsafety in a Typical Overcrowded Emergency of a Reaching Hospital in Tehran Capital City

Idealty patient length – of- stay in Emergency Department (ED) should not exceed 6 hours. Prolonged leogth-of-stay has deleterious effects on ED overcrowding. quality of patient care and patient satisfiction. To evaluate the causes of this problem the current study was conducted in a typical overcrowded ED of a general leaching hospital in Tehran City. METHODOLOGY: In this cross-sectional and prospective study, charts from patients held longer than 24 hours, in Emam Hossein Hospital of the Shahid Beheshti University, were reviewed from October 23, 2005 through Nomber 23, 2005, RESULTS: Of 3,630 patients, 222 had been held in the ED for more than 24 hours. cause of length-of-stay were not avirilable bed (68 patient) admission was indicated but delayed because more than one specialty were involved (21 patient) , 33 because they didn't have a specific diagnosis and 52 because of the completion OF their treatment course in the ED. Thirty-one left the ED against the medical advice and seventeen were refused admit hecause they were moribund and medically hopeless. CONCLUSION: Lengthy stay of patients in ED of teaching hospitals is a major problem. The most frequent cauus are limitation of inpatient beds, lack of a clear guideline to admit multi-specialty and moribund paticnt and those wirh uncretain diagnosis The following solutions are proposed (1) Creation of a holding unit (2) Delivery of more authority lo Emergency Physicians (3) pre- established rules of admitting controversial patients (4) Active inter-facility transfer. rransfer.