TITLE:
Creation and Validation of an Algorithm for Categorizing Emergency Room Visits as Justified or Unjustified: A Specialized Tool for the Israeli Healthcare System
AUTHORS:
Roman Leshinski, Ygal Plakht, Abdulhadi Farroujha
KEYWORDS:
Unjustified ED Visits, Algorithm, Healthcare System, Patient Referral, Emergency Care Optimization
JOURNAL NAME:
Open Journal of Emergency Medicine,
Vol.13 No.2,
June
6,
2025
ABSTRACT: Background: Unjustified emergency department (ED) visits are a global issue, contributing to overcrowding, reduced care quality, decreased patient satisfaction, and increased healthcare costs. A significant proportion of ED referrals are unjustified, likely due to the challenge of accurately determining a patient’s urgency and the lack of effective classification algorithms, particularly within Israel’s healthcare system. To address this gap, this study aims to develop and validate an algorithm to assist community-based physicians in classifying ED visits as justified or unjustified, ultimately improving referral decision-making. Methods: The algorithm was developed in two stages. First, 577 healthcare professionals classified ED visit characteristics—including diagnostic tests, treatments, and clinical conditions—as justified or unjustified. These classifications, along with a literature review and expert consultation, served as the foundation for the algorithm. In the second stage, the algorithm was validated using the Delphi method to achieve expert consensus. Results: In the first stage, 577 healthcare professionals classified ED visit reasons as justified or unjustified, with significant agreement (p