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 < 0.001) on 29 out of 31 cases, while two cases required expert panel review and were ultimately deemed justified. The second stage involved developing a four-step classification algorithm based on diagnostic tests, procedures, treatments, and discharge diagnoses, which was refined through expert discussions and validated using the Delphi method. The final algorithm serves as a structured decision-making tool to assess the justification of ED visits, supporting more accurate referral decisions in both community and emergency care settings. Conclusions: The validated four-step algorithm provides a structured tool for improving referral decision-making, potentially reducing unjustified ED visits and optimizing healthcare resource utilization.