Maintaining ambulatory care capacity through telemedicine during wartime: insights from a tertiary center's...

A state of war has the potential to profoundly disrupt routine, essential ambulatory hospital services, negatively impacting both acute hospitalizations and continuity of care. During June 2025, a war ignited between Israel and Iran, causing multiple casualties and substantial damage to essential healthcare facilities. This study examined the impact of the war on ambulatory visit volumes at Israel's largest tertiary medical center and assessed the contribution of telemedicine encounters to mitigating conflict-related disruptions.

This is a retrospective analysis of ambulatory service data collected at Sheba Tel HaShomer Medical Center between June 13 and June 24, 2025, compared to the corresponding period in the previous years (2021-2024), with a focus on the methodologies and managerial decisions implemented. We conducted an interrupted time series analysis using annual outpatient data from matched dates in 2021-2025. We modeled the proportion of visits delivered via telemedicine using segmented linear regression, incorporating calendar year as a continuous time variable and an indicator marking the onset of the 2025 regional war to estimate the immediate change in telemedicine use, adjusted for pre-war trends.

Between June 13 and 24, 2025, Sheba Medical Center conducted 53,158 ambulatory visits, of which 9,478 (17.8%) were via telemedicine. Half of the patients were male, and 47.8% were aged 25-64 years. From 2021 to 2024, telemedicine use increased gradually from 2.5% to 5.0% of visits. In 2025, utilization rose sharply following the Israel-Iran conflict. Interrupted time series analysis estimated a pre-war annual increase of 0.86 percentage points, with a 12.2 percentage point level change during the war (95% CI 9.0-15.5). Compared with 2024, total visits declined 20.0%, in-person visits fell 30.8%, and telemedicine visits increased 182.9%. The largest telemedicine growth occurred in cardiovascular (463.6%), pediatric (434.4%), and neurology/neurosurgery (350.5%) divisions, while pediatrics and psychiatry had the highest proportions of remote visits (40.2% and 33.9%, respectively).

A robust telemedicine infrastructure and well-established operational methodologies developed during peacetime may enable the continuity of ambulatory services during wartime. The rapid expansion of telemedicine capacity helped minimize the overall reduction in healthcare services available to the community.