[Unnecessary attendance at a hospital emergency service and linked factors]

To adapt to our environment a protocol that assesses the adequacy of attendance at a hospital emergency service (HES), in order to calculate the frequency of unnecessary attendance and to analyse possible linked factors.

Qualitative study using retrospective cross-sectional analysis of 269 records of patients attended at a third-level HES in Granada.

A heterogeneous group of experts (4 HES doctors and 4 PC doctors) agreed a scale for identifying unnecessary attendance at HES, which was then applied to a randomised sample of records of patients seen in the preceding year. An analysis was made of the proportion of unnecessary attendance and various associated factors: demographic variables, accessibility and variables involving the reason for consultation. The statistical techniques used were: confidence intervals to calculate percentage of unnecessary attendance, kappa index for agreement among observers on using the scale, and multiple logistic regression to analyse the association between unnecessary attendance and the factors studied.

Inter-observer concordance for 73% of the scale. 35% of visits unnecessary (95% CI, 29-41%). Unnecessary use of the HES was more by women (OR, 1.94, p = 0.023), patients from unreformed health areas (OR, 2.02, p = 0.028), those coming from home without having seen their general practitioner (OR, 2.54, p = 0.08), those who had had for longer the condition occasioning the attendance, and medical-type emergencies (OR, 1.52, p = 0.022).

More studies to test the reliability of the scale need to be performed. The apparent deduction is that a special reverence for emergency hospital care still exists and that this is sometimes used to side-step waiting-lists.