There has been a worldwide increase in demand for hospital emergency departments (EDs) and paediatric emergency departments (PEDs) over the past decade [1], [2]. This increase in demand is considered to be a widespread phenomenon in the EDs and PEDs of several developed western countries, irrespective of the organisation and structure of the healthcare system [3], [4]. The latest available figures for both services point to an overall increase of around 5–6% [5], [6]. Both services are particularly sought after in Spain, where there are around 23 million users per year [7], [8].

People who repeatedly and continuously visit the ED and PED are known as frequent users. Internationally, these users represent approximately 4–15% of those seeking care and around 25% of all visits [9], [10]. In Spain, the existing figures are higher, with approximately 35% of users seeking care [11]. There is no universal definition of the term frequent user, and little research is available, which may influence the different figures obtained [12]. However, analysis of the scientific literature shows that frequent users are commonly defined as those who have made more than four visits to the ED in the previous year and hyper-frequent users as those who have made more than ten visits to the ED in the previous year [9], [12], [13].

Both groups of users place an excessive demand on services. This leads to a disproportionate use of resources, to the detriment of both the users and the healthcare system. For users, this results in poorer quality follow-up care, treatment delays and increased mortality. Within the healthcare system, it leads to increased costs due to repeated diagnostic testing and overcrowding [8], [9], [10], [14]. Politicians and healthcare administrators around the world are therefore taking a keen interest and looking for solutions to prevent the problems caused by this type of user [9].

Scientific evidence shows that both frequent and hyper-frequent use of PEDs is associated with a number of specific parental characteristics. These include: younger age, being a foreign national, marital status, employment status, lower educational attainment, lower income level and the perceived need for emergency care when their children’s health is affected (perceived urgency). The characteristics of the children include: younger age, male sex and chronic illness. Features of the healthcare system include: living close to the centre, parental perception of the benefits of PED care and health insurance coverage [8], [13], [14].

Within the health professions, nurses are one of the groups in a position to deliver interventions aimed at reducing the rates of frequent users of these services. Data show that nursing interventions such as education around the flow of care, improving access to primary care (PC) and helping parents to identify serious symptomatology reduce around 14% of visits to the PED [15], [16]. Other interventions, such as health professional-led parent support groups, telephone helplines and online resources, may be beneficial, although their effectiveness varies [14], [17]. Appropriate responses to the problem therefore require an understanding of the multiple factors associated with frequent use, as well as public health policies and interventions designed to alleviate the problem [13], [18].

The high level of interest has led to numerous studies being carried out in the adult population [9], but there are few studies in the paediatric population and in the Spanish context [11]. The main objective of this study was therefore to identify the factors associated with frequent users of PEDs in Spain. Identifying these elements will allow for the development of more effective preventive interventions and policies tailored to the needs of this population. The underlying focus is to improve the efficiency and quality of emergency care in Spain.