Consensus Recommendations for Patients with Complex Dispositions: A Modified Delphi Study Among the Strengthening Essential Emergency Departments (SEED)
In brief
Delphi panel adopts definition for patients needing admission without acute illness
A modified Delphi process with 35 emergency-medicine experts reached consensus on the term "patients with complex dispositions," defined as individuals who require hospitalization because of discharge planning barriers despite lacking an acute condition. The group also identified five major barriers and six actionable recommendations, urging broader stakeholder validation and multidisciplinary research to address this overlooked patient group.
- Journal
- Journal of the American College of Emergency Physicians open (Q1)
- Published
- 9 September 2026
- Study design
- Practice guideline / consensus
- Evidence level
- Level 1, High (CEBM 1c)
- Authors
- Kathleen M Joseph, Jennifer Whitfield, Leah Warner, Alexandria Davis, Christian Arbelaez, Greg Buehler, et al.
- PMID
- 42751517
- DOI
- 10.1016/j.acepjo.2026.100505
Why clinicians should know about it
- Picked for Emergency Medicine (top studies of the week, 20 September 2026): Consensus on complex ED dispositions
Abstract
BACKGROUND: Some emergency department (ED) patients have complex needs requiring hospitalization but lack acute conditions that meet inpatient admission criteria. Although common, these cases have received little national attention. We convened emergency medicine experts to propose definitions, barriers, and calls to action for this population. METHODS: We conducted a modified Delphi study using iterative online surveys and an inperson meeting. Panelists were recruited from Strengthening Essential EDs (SEED), a consortium of 15 United States (US) academic safety-net hospitals. Panelists were asked to rank agreement with survey items on a 5-point Likert scale, with elimination of items that failed to reach consensus (defined as <3.75) after each round. Between rounds, we integrated all panelist suggestions and distributed anonymous controlled feedback. The inperson discussion used a modified Liberating Structures framework to elicit feedback, which was used to edit items in real time. RESULTS: In total, 35 of 67 (52.2%) panelists from 12 of 15 (80%) institutions attended the inperson discussion, and 22 panelists from 13 institutions participated in ≥1 Delphi survey. The panel reached consensus on a single term and definition-recommending "patients with complex dispositions" defined as "a patient who requires hospitalization due to complex disposition planning needs and identified barriers to safe discharge." The panel also reached consensus on 5 key barriers and 6 calls to action for future work. CONCLUSIONS: We recommend the term "patients with complex dispositions" to describe patients who require hospitalization due to identified barriers to safe discharge. This term, along with the proposed definition, identified barriers, and calls to action, should be considered and evaluated by a larger and more diverse stakeholder group in the future. We further encourage future work by multidisciplinary teams to evaluate and address this issue in the US health care system.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.