Cirugía y Cirujanos

Contents by Year, Volume and Issue

Table of Contents

General Information

Instructions for Authors

Message to Editor

Editorial Board

>Journals >Cirugía y Cirujanos >Year 2010, Issue 6

Loría-Castellanos J, Flores-Maciel L, Márquez-Ávila G, Valladares-Aranda MÁ
Frequency and factors associated with misuse of hospital emergency services
Cir Cir 2010; 78 (6)

Language: Español
References: 42
Page: 508-514
PDF: 265.97 Kb.

Full text


Background: Situations that affect the saturation of emergency services mention their misuse by patients. Identifying factors associated with this phenomenon will allow us to develop strategies to optimize its operation.
Methods: We conducted an observational study. The study was approved by the Research Committee and included randomized patients who requested emergency consultations during the month of October 2008. An instrument was expressly designed to study the application for inadequate attention and five indicators. We used descriptive statistics and odds ratio.
Results: We conducted 718 interviews: 74.14% in adults and 25.45% in children. Of these, 61.11% were male and the mean age was 65.15 ± 19.32 years. Of the consultations, 65.17% were considered inappropriate (61.67-75.20% for adult and pediatric patients). The association of factors are significant according to the following: service consultation on Friday (OR 4.21) and Monday (OR 3.45), perception of receiving rapid attention (OR 3.24), being denied care in this unit (OR 3.14), lower level of primary education (OR 3.21), arriving during the evening shift (OR 2.56), affiliation with family medical unit 35 (OR 2.19), and earning a minimum wage income (OR 2.27).
Conclusions: Misuse of emergency department services is higher than that reported worldwide. Factors associated with this deviation may be solved by improving the processes of first-level units

Key words: Emergency services, quality of health care.


  1. Hansagi H, Olsson M, Sjöberg S, Tomson Y, Göransson S. Frequent use of the hospital emergency department is indicative of high use of other health care services. Ann Emerg Med 2001;37:561-567.

  2. Ministerio de Sanidad. Informes de las subcomisiones para la comisión de análisis y evaluación del sistema nacional de salud para el parlamento español. Madrid, España: Ministerio de Sanidad; 1991.

  3. Servicio Andaluz de Salud. Plan funcional de la sección de urgencias del servicio de cuidados críticos y urgencias. Disponible en http://www.juntadeandalucia.es/servicioandaluzdesalud/principal/documentosAcc.asp?pagina=pr_ges_cal_PlanAndUrgEmerg2_6&file=/contenidos/gestioncalidad/PlanAndUrgenciasEmergencias/Plan_Func_Urgencias_SCCUPlan_Func_Urgencias_SCCU.htm

  4. Moreno-Ruiz P, Jiménez-Rosendo EM, Rivas-Castro MA, León-Rosales Y, Castillo-Bueno H, Bellot-Iglesias JL. Características de pacientes derivados a Servicio de Cuidados Críticos y Urgencias (SCCU) desde Dispositivo de Cuidados Críticos y Urgencias (DCCU) integrado en el recinto hospitalario. Med Familia 2003;3:171-176.

  5. Tudela P, Módol JM. Urgencias hospitalarias. Med Clin 2003;120:711-716.

  6. Antón P, Peiró S, Aranaz JM, Calpena R, Company A. AdeQuos, un instrumento para la evaluación de la adecuación de la hospitalización en el pase de visita. Rev Calidad Asistencial 2002;17:591-599.

  7. Moyá-Ruiz C, Peiró S, Meneu R. Effectiveness of feedback to physicians in reducing inappropriate use of hospitalization. Int J Qual Health Care 2002;14:305-312.

  8. Milla Santos J. Urgencias médicas, algo más que una serie televisiva. Med Clin 2001;117:295-296.

  9. Derlet RW, Richards JR. Overcrowding in the nation’s emergency departments: complex causes and disturbing effects. Ann Emerg Med 2000;35:63-68.

  10. Del Castillo Rey M, Huguet J, Bravo J, Cortada L. Estudio del área de urgencias de un hospital general. Grado de adecuación de las visitas. Med Clin 1986;87:539-542.

  11. Padgett DK, Brodsky B. Psychosocial factors influencing non-urgent use of the emergency room: a review of the literature and recommendations for research and improved service delivery. Soc Sci Med 1992;35:1189-1197.

  12. Burt CW, McCaig LF. Trend in hospital emergency department utilization: United States, 1992-99. Vital Health Stat 2001;150:1-34.

  13. Cunningham PJ, Clancy CM, Cohen JW, Wilets M. The use of hospital emergency departments for nonurgent health problems: a national perspective. Med Care Res Rev 1995;52:453-474.

  14. Liu T, Sayre MR, Carleton SC. Emergency medical care: types, trends, and factors related to nonurgent visits. Acad Emerg Med 1999;6:1147-1152.

  15. Anon. Most visits to ER unnecessary, surveys says. Health Care Strategic Man 2002;20:6-7.

  16. Santos-Eggimann B. Increasing use of the emergency department in a Swiss hospital: observational study based on measures of the severity of cases. Br Med J 2002;324:1186-117.

  17. Rask KJ, Williams MV, Parker RM, McNagny SE. Obstacles predicting lack of a regular provider and delays in seeking care for patients at an urban public hospital. JAMA 1994;271:1931-1933.

  18. Young GP, Wagner MB, Kellermann AL, Ellis J, Bouley D. Ambulatory visits to hospital emergency departments. Patterns and reasons for use. JAMA 1996;276:460-465.

  19. Sarver JA, Cydulka RA, Baker DW. Usual source of care and nonurgent emergency department use. Acad Emerg Med 2002;9:916-923.

  20. Zuckerman, S, Chen Y. Characteristics of occasional and frequent emergency department users. Do insurance coverage and access to care matter? Med Care 2004;42:176-182.

  21. Lang T, Davido A, Diakite B, Agay E, Viel JF, Flicoteaux B. Non-urgent care in the hospital medical emergency department in France: how much and which health needs does it reflect? J Epidemiol Community Health 1996;50:456-462.

  22. Murphy AW, Plunkett PK, Bury G, Leonard C, Walsh J, Lynam F, et al. Effect of patients seeing a general practitioner in accident and emergency on their subsequent reattendance: cohort study. Br Med J 2000;320:903-904.

  23. Pereira S, Oliveira A, Quintas M, Almeida J, Marujo C, Pizarro M, et al. Appropriateness of emergency department visits in a Portuguese University Hospital. Ann Emerg Med 2001;37:580-586.

  24. Grupo de Trabajo de la Sociedad Andaluza de Medicina Familiar y Comunitaria. Ordenación de las urgencias en atención primaria. Aten Primaria 1992;9:269-275.

  25. Alberola V, Rivera F. La atención primaria como determinante de la utilización del servicio de urgencias hospitalario. Aten Primaria 1994;14:825-828.

  26. Bolívar I, Balanzó X, Armada A, Fernández JL, Foz G, Sanz E, et al. El impacto de la reforma de la atención primaria en la utilización de servicios de urgencias hospitalarios. Med Clin 1996;107:289-295.

  27. Marín N, Caba A, Ortiz B, Pérez-Tornero E, Martínez L, López M, et al. Determinantes socioeconómicos y utilización de los servicios hospitalarios de urgencias. Med Clin 1997;108:726-729.

  28. Miró O, Sánchez M, Coll-Vinent B, Millá J. Estimación del efecto relativo que ejercen los determinantes externos e internos sobre la eficacia de un servicio de urgencias de medicina. Med Clin 2000;115:294-296.

  29. Williams RM. The costs of visits to emergency departments. N Engl J Med 1996;334:642-646.

  30. Murphy AW, Bury G, Plunkett PK, Gibney D, Smith M, Mullan E, et al. Randomised controlled trial of general practitioner versus usual medical care in an urban accident and emergency department: process, outcome, and comparative cost. Br Med J 1996;312:1135-1142.

  31. Dale J, Lang H, Roberts JA, Green J, Glucksman E. Cost effectiveness of treating primary care patients in accident and emergency: a comparison between general practitioners, senior house officers, and registrars. Br Med J 1996;312:1340-1344.

  32. Peiró S, Sempere T, Oterino D. Efectividad de las intervenciones para reducir la utilización inapropiada de los servicios hospitalarios de urgencias. Revisando la literatura 10 años después del informe del Defensor del Pueblo. Econ Salud 1999;12:1-15.

  33. Boushy D, Dubinsky I. Primary care physician and patient factors that result in patients seeking emergency care in a hospital setting: the patient’s perspective. J Emerg Med 1999;17:405-412.

  34. Baker DW, Stevens CD, Brook RH. Regular source of ambulatory care and medical care utilization by patients presenting to a public hospital emergency department. JAMA 1994;271:1909-1912.

  35. Clancy CM, Eisenberg JM. Emergency medicine in population-based systems of care. Ann Emerg Med 1997;30:800-803.

  36. Oterino D, Peiró S, Calvo R, Sutil P, Fernández O, Pérez G, et al. Utilización inadecuada de un servicio de urgencias hospitalario. Una evaluación con criterios explícitos. Gac Sanit 1999;13:361-370.

  37. Ibáñez F, Gutiérrez B, Olaskoaga A. Estudio de la utilización de servicios de urgencias hospitalarios por la población de un EAP: grado de adecuación. Aten Primaria 1991;8:764-769.

  38. Grumbach K, Keane D, Bindman A. Primary care and public emergency department overcrowding. Am J Public Health 1993;83:372-378.

  39. Andersen R, Newman JF. Societal and individual determinants of medical care utilization in the United States. Millbank Memorial Fund Q 1973;51:95-124.

  40. McCusker J, Karp I, Cardin S, Durand P, Morin J. Determinants of emergency department visits by older adults: a systematic review. Acad Emerg Med 2003;10:1362-1370.

  41. Derlet RW, Kinser D, Ray L, Hamilton B, McKenzie J. Prospective identification and triage of nonemergency patients of an emergency department: a 5 year study. Ann Emerg Med 1995;25:215-223.

  42. Lowe RA, Abbuhl SB. Appropriate standards for “appropriateness” research. Ann Emerg Med 2001;37:629-632.

>Journals >Cirugía y Cirujanos >Year 2010, Issue 6

· Journal Index 
· Links 

Copyright 2019