Non-clinical factors influencing discharge and admission decisions in the emergency department: a focus group study among Israeli physicians.

Background: Emergency department (ED) physicians frequently make high-stakes decisions under time constraints. While clinical indicators are essential, non-clinical factors often shape whether a patient is admitted or discharged. However, the specific non-clinical influences and how physicians perceive them remain underexplored.

Objective: To identify and categorize non-clinical factors that influence admission decisions among ED physicians.

Methods: This qualitative study involved five focus groups with 42 participants (specialists, residents, and physician assistants) across five Israeli hospitals. A semi-structured discussion guide, informed by literature and expert interviews, was used. Audio-recordings were transcribed and analyzed thematically using a mixed inductive and deductive approach.

Results: Three overarching domains of non-clinical influences emerged: (1) patient-related factors (preferences, social support, functional status, access to care), (2) physician-related factors (experience, risk tolerance, workload, prior errors), and (3) system-level factors (bed capacity, ED protocols, communication gaps, resource availability). Physicians often weighed these elements alongside clinical indications for admission, particularly in borderline cases. Functional status and family support frequently influenced safe discharge decisions. Physician experience emerged as a buffer against risk-averse behaviors. System-level pressures, such as ED crowding and administrative policies, further shaped clinical discretion.

Conclusion: Non-clinical factors substantially influence ED disposition decisions. These findings highlight the need for policy reforms, decision-support tools, and further research to guide when and how non-clinical factors should inform care. This study offers a framework for understanding such influences and can inform interventions aimed at improving ED efficiency and patient outcomes.

Clinical trial number: Not applicable.