Appropriateness of admission in an emergency department: reliability of assessment and causes of failure.

The validity of a modified version of the appropriateness evaluation protocol was assessed in a sample of patients aged 15 and over admitted by means of the emergency department of one of the Paris hospitals. As measured among 371 patients, the reliability of the indicator was high. The prevalence of inappropriate admissions (IA) was found to be 20% using the expert opinions and 25% the instrument. Homelessness was associated with a higher prevalence of IA (34%). Other social factors and age were not related to IA. According to the experts' opinions, difficulties in organizing the continuity of care for patients examined in the emergency room were one of the main causes for IA.