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Objective: To gain insight into the shortage in health care capacity for patients who require immediate admission to hospital., Design: Prospective, descriptive., Method: During the period 1 March-30 November 2001, data were collected on all patients presenting at the casualty department at the Sint Lucas Andreas Hospital in Amsterdam, the Netherlands, who had a surgical, internal medicine or neurological condition which required immediate admission and who could not be admitted due to a shortage in health care capacity. The following data were registered: date of transfer, age, gender, diagnosis, referring specialty, time of telephone call, accepting hospital and time of acceptance. During the same period, the surgery department also noted details of patients requiring immediate admission or transfer whom they turned away after presentation via the telephone by either the general practitioner or a different hospital., Results: 131 patients could not be admitted, 68 men and 63 women with a mean age of 69 years. The distribution across the specialties was as follows: surgery: 63 patients (48%; mean age: 68 years); internal medicine: 48 patients (37%; 65 years); neurology: 20 patients (15%; 74 years). The most common reasons for admission were proximal femur fractures (24; 18%) and gastrointestinal disorders (27; 21%). Mean duration from making the telephone call until acceptance elsewhere was 70 min (range: 1-330) for surgery, 42 min (5-180) for internal medicine and 116 min (10-870) for neurology. The transfer of patients with proximal femur fractures (97 min) and cerebrovascular accident (129 min) took the longest. During the same period, 170 patients were refused by the department of surgery for first-time admission or transfer.