Influence of non-clinical factors on emergency department decision-making: a Delphi study
Dublin Core
Title
Influence of non-clinical factors on emergency department decision-making: a Delphi study
Subject
Emergency medicine, Decision making, Delphi study, Non clinical factors, ED admissions
Description
Background Disposition decisions in the emergency department (ED) are expected to rely primarily on clinical need,
yet in practice, non-clinical factors frequently shape outcomes. These influences are poorly documented and rarely
prioritized systematically. This study sought to achieve consensus among ED physicians on the most impactful non-
clinical factors affecting admission decisions.
Methods We conducted a two-round Delphi survey among 34 ED physicians across Israel. Candidate non-clinical
factors were derived from prior research and classified into three domains: patient-related, physician-related, and
system-related. Participants rated each factor on a Likert scale regarding its frequency of influence, and consensus was
defined as ≥66% agreement. Non-parametric tests were used to assess associations with physician characteristics.
Results Consensus was reached for all 21 factors after two Delphi rounds. Patient-related factors such as personal
preference and family support were rated as commonly influential, while socioeconomic status was considered rarely
influential. Physician-related factors including years of experience, field of expertise, and fatigue were commonly
influential, whereas gender and cultural background were not. Among system-related factors, inpatient bed capacity
and home care availability were frequently influential, whereas adherence to quality indicators and ED arrival time
were rarely considered determinants. No significant variation was observed across physician subgroups.
Conclusion This Delphi study highlights that ED admission decisions are shaped not only by clinical needs but also
by contextual non-clinical factors spanning patient, physician, and system domains. Recognizing and addressing
these influences may support more standardized, equitable, and efficient ED decision-making and inform targeted
interventions at institutional and policy levels.
Clinical trial number Not applicable.
Keywords Emergency medicine, Decision making, Delphi study, Non clinical factors, ED admissions
yet in practice, non-clinical factors frequently shape outcomes. These influences are poorly documented and rarely
prioritized systematically. This study sought to achieve consensus among ED physicians on the most impactful non-
clinical factors affecting admission decisions.
Methods We conducted a two-round Delphi survey among 34 ED physicians across Israel. Candidate non-clinical
factors were derived from prior research and classified into three domains: patient-related, physician-related, and
system-related. Participants rated each factor on a Likert scale regarding its frequency of influence, and consensus was
defined as ≥66% agreement. Non-parametric tests were used to assess associations with physician characteristics.
Results Consensus was reached for all 21 factors after two Delphi rounds. Patient-related factors such as personal
preference and family support were rated as commonly influential, while socioeconomic status was considered rarely
influential. Physician-related factors including years of experience, field of expertise, and fatigue were commonly
influential, whereas gender and cultural background were not. Among system-related factors, inpatient bed capacity
and home care availability were frequently influential, whereas adherence to quality indicators and ED arrival time
were rarely considered determinants. No significant variation was observed across physician subgroups.
Conclusion This Delphi study highlights that ED admission decisions are shaped not only by clinical needs but also
by contextual non-clinical factors spanning patient, physician, and system domains. Recognizing and addressing
these influences may support more standardized, equitable, and efficient ED decision-making and inform targeted
interventions at institutional and policy levels.
Clinical trial number Not applicable.
Keywords Emergency medicine, Decision making, Delphi study, Non clinical factors, ED admissions
Creator
Ofer Kobo1,2,3*, Itay Itzhaki1,4,5, Michael J. Drescher6
, Jacob Glazer7,8, Avi Israeli9,10, Bruce E. Landon11 and
Shuli Brammli-Greenberg1
, Jacob Glazer7,8, Avi Israeli9,10, Bruce E. Landon11 and
Shuli Brammli-Greenberg1
Source
https://doi.org/10.1186/s12873-025-01425-3
Date
2026
Contributor
Peri Irawan
Format
PDF
Language
ENGLISH
Type
TEXT
Files
Collection
Citation
Ofer Kobo1,2,3*, Itay Itzhaki1,4,5, Michael J. Drescher6
, Jacob Glazer7,8, Avi Israeli9,10, Bruce E. Landon11 and
Shuli Brammli-Greenberg1, “Influence of non-clinical factors on emergency department decision-making: a Delphi study,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12025.