However, other ON-01910 research buy studies showed higher percentage of hospitalization through the ED [7,14]. These variations in hospital admission rates could be due to several factors including hospital size, number and types of specialties in the hospital, triage system, patients’ eligibility, and insurance coverage. Admission rates are generally correlated with CTAS triage level; in this study, the majority of our ED patients were Inhibitors,research,lifescience,medical categorized as levels IV and V. Furthermore, our hospital is a specialized tertiary care institute, where patients are transferred from other hospitals in the region. This may explain, in part, the low admission

rates through the ED. Previous studies showed that up to 15% of patients left ED without receiving any medical attention [15-18]. Likewise, our ED’s estimated LWBS rate is approximately 9.8%, however, this Inhibitors,research,lifescience,medical is higher than our quality indicator of < 2%. Using CTAS, recent study in United Arab Emirates, showed a rate of 4.7% LWBS [19], Canadian studies reported rates between 3 - 3.57% [20,21], and 7.4 - 15.0% in the USA [17,22-24]. These international variations in LWBS may reflect differences in culture, ED structure or service delivery. "Left without being seen" is related to many factors, such as ED efficiency, patient volume and Inhibitors,research,lifescience,medical acuity, understaffing and overcrowding [23,25]. In keeping with CTAS objectives, our data demonstrated that of 118 patients, who

left without being seen during the study period, none Inhibitors,research,lifescience,medical were in Levels I or II (Resuscitation or Emergent), and only 14 (11.9%) were in Level III. This implies that in our ED patients who LWBS, generally, have conditions of a less acute and less urgent nature. Waiting time studies offer constructive information to identify system inefficiencies and for benchmarking purposes. With a growing population Inhibitors,research,lifescience,medical and an increasing

demand for medical care in EDs throughout the Gulf region and elsewhere, there is a need for comparative studies both locally, as well as, internationally to document and account for avoidable areas of delay in the care of emergency patients, and hence, improve quality of care. Our study is one of a few, which examines the CTAS in EDs outside of Canada. Limitations The data presented in this study comes from only one institution, which may limit the ability to generalize our results to other facilities, because this institute has different setting and patient characteristics, than most of the CTAS published studies. However, we believe that the outcomes either reflect the reality of most EDs that use CTAS. Conclusion We conclude that the CTAS may be implemented, with achievable objectives, in hospitals outside Canada. Time to see physician, total LOS, and LWBS are effective markers of performance of ED and the quality of triage. RTP and LOS profiles, stratified by triage level, are essential for the management of ED and improving patient flow through collaborative efforts. Competing interests The authors declare that they have no competing interests.