Appropriateness of soldiers' referrals to the emergency department

Background: Emergency departments (ED) in Israel deal with a large number of referrals from the Israel Defense Force. In a recent study, we observed that only 3% of soldiers referred to the ED in Soroka Medical Center were hospitalized. Objectives: The purpose of this study was to determine the appropriateness of soldier referrals to the ED, using a proposed set of criteria for ED appropriateness. Methods: A retrospective assessment of 707 discharge letters of soldiers from the ED was performed. A set of criteria to assess the appropriateness of soldier's referrals to the ED was developed. The criteria were as follows: (1) resuscitation, (2) hospitalization, (3) laboratory examination, (4) X-ray examination, (5) medical treatment, and (6) specialist consultation. A referral was considered appropriate if at least one criterion was positive. Results: According to the proposed criteria of ED military appropriateness, 586 of 707 referrals (83%) were considered as appropriate. Appropriateness of the referrals according to sections of the ED was as follows: orthopedics (97%), internal medicine (63%), ophthalmology (100%), and neurosurgery (100%). Conclusions: A discrepancy exists between the high proportion of appropriate soldiers' referrals to the ED and the low hospitalization proportion. Organizational steps should be undertaken in the Israel Defense Force to decrease excess military use of civilian ED services.