Inappropriate use of an accident and emergency department: magnitude, associated factors, and reasons--an approach with explicit criteria

Ann Emerg Med. 2001 Jun;37(6):568-79. doi: 10.1067/mem.2001.113464.


Background: We evaluate the appropriateness of medical visits to the accident and emergency department (A&ED) of a university hospital using an instrument based on explicit and objective criteria, analyze the association between inappropriate visits and certain factors, and identify reasons for inappropriate use.

Methods: This concurrent review of a random sample of 2,980 adult medical patients' visits to the A&ED of the hospital of Elche uses the Hospital Urgencies Appropriateness Protocol, an instrument based on explicit criteria. We analyze the association between inappropriate use and specific factors, and provide a descriptive analysis of reasons for inappropriate use assigned by A&ED staff.

Results: Of the total number, 882 (29.6%) of the visits were evaluated as inappropriate. Inappropriate use was associated with younger patients, use of own means of transportation, referral by the hospital, certain months of the year, and certain diagnostic groups of lesser severity. The most frequent reasons for inappropriate use were the patients' greater trust in the hospital than primary care (451 [51.1%]), inappropriate use of services by patients (160 [18.1%]), and inappropriate referrals by primary care physicians (142 [16.1%]).

Conclusion: Inappropriate use represents an important percentage of use of the A&ED. Many reasons contribute to it, although foremost among them is patient preference (and the convenience and accessibility) of these services compared with primary care.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Concurrent Review
  • Cross-Over Studies
  • Diagnosis-Related Groups / classification
  • Diagnosis-Related Groups / statistics & numerical data
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Health Services Misuse / statistics & numerical data*
  • Health Services Research
  • Hospitals, Public / statistics & numerical data
  • Hospitals, University / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / psychology*
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Primary Health Care / statistics & numerical data
  • Referral and Consultation / organization & administration
  • Residence Characteristics / statistics & numerical data
  • Risk Factors
  • Severity of Illness Index
  • Spain / epidemiology
  • Surveys and Questionnaires
  • Transportation / statistics & numerical data