Pediatric emergency department utilisation during Ramadan: a retrospective cross-sectional study

Objective To investigate the impact of Ramadan on patient characteristics, diagnoses and metrics in the paediatric emergency department (PED). Design Retrospective cross-sectional study. Setting PED of a tertiary care centre in Lebanon. Patients All paediatric patients. Exposure Ramadan (June 2016 and 2017) versus the months before and after Ramadan (non-Ramadan). Main outcome measures Patient and illness characteristics and PED metrics including peak patient load; presentation timings; length of stay; and times to order tests, receive samples and report results. Results We included 5711 patients with mean age of 6.1 +/- 5.3 years and 55.4% males. The number of daily visits was 28.3 +/- 6.5 during Ramadan versus 31.5 +/- 7.3 during non-Ramadan (p=0.004). The peak time of visits ranged from 18:00 to 22:00 during non-Ramadan versus from 22:00 to 02:00 during Ramadan. During Ramadan, there were significantly more gastrointestinal (GI) and trauma-related complaints (39.0% vs 35.4%, p=0.01 and 2.9% vs 1.8%, p=0.005). The Ramadan group had faster work efficiency measures such as times to order tests (21.1 +/- 21.3 vs 24.3 +/- 28.1 min, p<0.0001) and to collect samples (50.7 +/- 44.5 vs 54.8 +/- 42.6 min, p=0.03). Conclusions Ramadan changes presentation patterns, with fewer daily visits and a later peak time of visits. Ramadan also affects illness presentation patterns with more GI and trauma cases. Fasting times during Ramadan did not affect staff work efficiency. These findings could help EDs structure their staffing to optimise resource allocation during Ramadan.