Researchers: Ygal Plakht ¹, Roman Leshinski ¹

Background: Israel’s healthcare system faces increasing pressure on Emergency Departments (EDs), partly due to non-urgent visits that could have been treated in community settings. These visits negatively impact quality of care, patient satisfaction, staff motivation, and system-wide efficiency.

Objectives: This study aimed to develop and validate an algorithm for classifying ED visits as justified or unjustified, estimate the prevalence of unjustified visits, identify characteristics of patients and visits, assess cost differences, and examine the impact of the COVID-19 pandemic.

Method: The research was conducted in three phases: (1) a qualitative phase involving in-depth interviews with senior healthcare professionals; (2) a mixed-methods phase in which 577 healthcare workers classified ED visit scenarios, followed by expert validation of the algorithm using the Delphi method; and (3) a quantitative retrospective analysis of approximately 2.8 million ED visits across four hospitals between 2018–2022. Classification of visits as justified or not in phase three was based on the developed algorithm.

Findings: 49% of ED visits were unjustified, mainly among younger patients, self-referrals, and vague complaints. During the COVID-19 pandemic, unjustified visit rates declined.

Conclusions: On average, unjustified visits were 495 NIS less costly than justified ones, and reducing such visits could yield annual savings of approximately 550 million NIS nationally.

Recommendations: The study highlights the need to strengthen community care, enhance triage mechanisms, and develop technological tools for early identification of non-urgent ED visits.

Research end date: 05/2025