Hospital beds are an important and costly resource for all health systems. Objectives: to assess the appropriateness of hospitalization days and identify risk factors associated with extra length of hospital stay. Methods: Record analysis and indepth interview with hospital managers were conducted to review hospital rates and bed management policy for different departments of Zagazig university hospitals in 2012. Then, non emergency settings in 4 selected departments were studied in a cross sectional study involved 200 patients and 108 physicians. Patients were interviewed and their bed days were assessed by using appropriateness evaluation protocol(AEP). Physicians were asked to complete a questionnaire on bed cycle and their recommendations were recorded. Results: Record analysis and indepth interview revealed considerable variability in bed occupancy pattern among various departments with overall bed occupancy rate of 67.9%. In the 4 detailed studied departments, percentages of inappropriate hospital admission and stay were 19% and 59 % respectively. Elective admission and being admitted for first time were the significant predictors of inappropriate admission on logistic regression. The main causes of inappropriate stay were waiting for operating room diagnostic or therapeutic procedures in patients in medical departments and persistence of symptoms or occurrence of complications in surgical departments . Poor records and lack of application of clinical guidelines are the main causes of extra length of stay from physicians, prospective. Conclusion: Optimal use of hospital beds remains a challenge at Zagazig university hospitals .So, application of standardized electronic patients records, proper inter departmental communications, proper discharge planning, in addition to planning for rehabilitative and social services are recommended.