title: [Accident and emergency department inappropriate utilization. An evaluation with explicit criteria].
abstract: BACKGROUND
  Several studies have shown a growth in the number of visits to accident and emergency (A&E) hospital departments with a high proportion of inappropriate utilization. Methods to identify improper use based on implicit criteria limit the comparisons between hospitals. The aim of this study is to know the proportion of inappropriate attendance's in an A&E department and their associated factors, using a method with objective criteria.
  
  
  METHODS
  An instrument based on diagnosis-independent explicit criteria was used to identify inappropriate visits in a random sample of 1845 14-year-old greater patients attended to A&E medical services, and the factors associated with improper demand were analysed.
  
  
  RESULTS
  The proportion of inappropriate attendance's was of the 26,8% (495/1. 845). The unadjusted analysis show that the smaller age, absence of comorbidity, spontaneous visit and some diagnostic groups (diseases of the skin, muscle-skeletal, mental, and bad defined symptoms) were associated to a greater proportion of improper use. Upon adjusting the variables through logistics regression, the age, associated pathology, the spontaneous attendance's and diagnostic groups, maintained the association with improper use, but other variables as woman gender, and night hours were also associated to inappropriate utilization.
  
  
  CONCLUSIONS
  At least the fourth part of the attendance's in the A&E medical services do not require urgent attention. Inappropriate utilization is associated to characteristic of the patient and the attended process.
authors.affiliation: Instituto de Investigación en Servicios de Salud, Valencia, España. doterino@mx3.redestb.es
authors.forename: D
authors.initials: D
authors.lastname: Oterino
authors.forename: S
authors.initials: S
authors.lastname: Peiró
authors.forename: R
authors.initials: R
authors.lastname: Calvo
authors.forename: P
authors.initials: P
authors.lastname: Sutil
authors.forename: O
authors.initials: O
authors.lastname: Fernández
authors.forename: G
authors.initials: G
authors.lastname: Pérez
authors.forename: P
authors.initials: P
authors.lastname: Torre
authors.forename: M
authors.initials: M
authors.lastname: López
authors.forename: T
authors.initials: T
authors.lastname: Sempere
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003953:Diagnosis-Related Groups; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006783:Hospitals, State / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008485:Medical Audit; D008499:Medical Records; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013030:Spain