title: [Unnecessary attendance at a hospital emergency service and linked factors].
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Qualitative study using retrospective cross-sectional analysis of 269 records of patients attended at a third-level HES in Granada.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Servicio de Cuidados Críticos y Urgencias del Hospital Clínico, Universitario San Cecilio, Granada, Spain. jcanteroh@medynet.com
authors.forename: J
authors.initials: J
authors.lastname: Cantero Hinojos
authors.forename: E
authors.initials: E
authors.lastname: Sánchez-Cantalejo Ramírez
authors.forename: J
authors.initials: J
authors.lastname: Martínez Olmos
authors.forename: J
authors.initials: J
authors.lastname: Maeso Villafaña
authors.forename: J J
authors.initials: JJ
authors.lastname: Rodríguez Jiménez
authors.forename: M A
authors.initials: MA
authors.lastname: Prieto Rodríguez
authors.forename: J M
authors.initials: JM
authors.lastname: Jiménez Martín
mesh_terms: D000328:Adult; D002648:Child; D002985:Clinical Protocols; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013030:Spain; D014600:Utilization Review
vernacular_title: Inadecuación de las visitas a un servicio de urgencias hospitalario y factores asociados.