title: [Identification of problems and proposals for improving outpatient emergency care in Navarre: a Delphi study].
abstract: BACKGROUND
  Two years ago there were alterations to outpatient A and E departments in Navarre; in particular, a rural A and E service (Servicio de Urgencias Rural- SUR) was set up, which coexists geographically with the normal A and E service. The aim of this study is to determine the opinion of experts on problems and recommendations for improvements that affect outpatient A and E services.
  
  
  METHODS
  A Delphi study was carried out with the participation of 37 experts (doctors and nurses). Three successive rounds of questionnaires were completed using email. The final questionnaire identified degree of agreement with the group's ideas, and the 15 most relevant problems and recommendations were identified; those ideas that were selected achieved at least 50% agreement and their priority was above 25%. We grouped the ideas using a hierarchic cluster analysis.
  
  
  RESULTS
  Four cluster problems were identified; the most outstanding amongst them being "the population uses A and E for banal pathologies, just like any other consultation" with a score of 297 points. Outstanding amongst the recommendations, with 3 identified clusters, were the "need to design a strategic plan for A and E care with resources appropriate to the needs" (310 priority points) and "sending clear messages to the population on the correct use of A and E" (192 priority points).
  
  
  CONCLUSIONS
  The Delphi method identifies problems and improvement areas through consensus.
authors.affiliation: Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain. ignacio_perez_ciordia@hotmail.com
authors.forename: I
authors.initials: I
authors.lastname: Pérez-Ciordia
authors.forename: A
authors.initials: A
authors.lastname: Brugos Larumbe
authors.forename: F
authors.initials: F
authors.lastname: Guillén-Grima
authors.forename: C Fernández-Martínez
authors.initials: CF
authors.lastname: de Alegria
authors.forename: I Aguinaga
authors.initials: IA
authors.lastname: Ontoso
mesh_terms: D000553:Ambulatory Care / Q000592:standards*; D003697:Delphi Technique; D004632:Emergency Medical Services / Q000592:standards*; D006801:Humans; D058996:Quality Improvement; D011787:Quality of Health Care; D013030:Spain; D011795:Surveys and Questionnaires