BACKGROUND: Speed of giving services in medical centers, especially in emergency department, play an important role in reducing death and handicap. The action of emergency department can have a great effect on other wards actions. METHODS: This triangulation study conducted in 2005 in three steps. In the first step, problems of the emergency department of Al-ZAHRA hospital were extracted using an open questionnaire filled by employed personnel. In the second step, 14 managers of the center attended a meeting discussing those problems. Based on the gathered data, a closed questionnaire was designed and in the third step it was given to 64 hospital employee. Data were analyzed using SPSS software. RESULTS: In the first group (managers), 5 problems were scored more: security problem (70%), not paying attention to educational hierarchy (70%), absence of on-watch resident in the emergency department (60%), absence of a standard clinical protocol (60%), and absence of team work (38%). The second group (employed personnel of emergency department), gave more scores to nonscheduled transfers from other centers (70.6%), absence of on-watch resident in the emergency department (61.8%), not determining the correspondence attending for a multiple-trauma patient (58.9%), absence of team work (52.9%).CONCLUSION: Emergency ward has increased the chance of living for patients receive urgent medical services, in the first hours after an accident or a disease attack, known as "golden time"; so absence of on-watch resident in the emergency department of educational hospital has a negative effect on making decisions and functioning and mostly.