'Growing pressure' on A&E units
An increase in patient numbers is putting Scotland's accident and emergency departments under growing pressure, according to a report.
Audit Scotland said a 9% increase in patients over the past decade meant NHS costs had grown by almost £30m in three years.
Many staff believe patients are sometimes "inappropriately" admitted to hospital to meet targets, it said.
The British Medical Association (BMA) described the finding as "scandalous".
The Audit Scotland study said about 1.4 million people attended accident and emergency units in Scotland during 2008-9, costing the NHS £148m, or 1% of overall spending on health services.
That represented a rise from £120m over three years.
Attendance levels grew from 1.39 million in 1999-2000 to 1.52 million last year. The Scottish government set a target to reduce attendance rates.
The study found "inadequate information" to demonstrate the best use of care resources and discovered "emerging staffing difficulties".
A total of 55% of staff felt patients were admitted to hospital to avoid breaching a four-hour waiting time target.
However, four out of five patients rated the care they received as excellent or very good.
Auditor General Robert Black said: "Patients are happy with the care they receive and the length of time they wait to be treated has reduced with the introduction of a four-hour target.
"However, information about the quality and effectiveness of care provided is limited, for example there is little information about the medical condition of patients attending emergency departments.
"The services available for vulnerable groups, including people with a mental health problem, vary across Scotland.
"There are also emerging staffing issues, such as shortages in junior doctors and the impact of European working hours legislation, that must be tackled at a national level, not just locally.
Dr Brian Keighley, chairman of the BMA in Scotland, said "A number of issues" must be addressed.
He added: "Reports that more than half of doctors and nurses surveyed by Audit Scotland believed that patients are sometimes inappropriately admitted to hospital to avoid breaching the four-hour waiting times target is scandalous and I would urge the government to investigate this matter.
"They must also consider the issue of trolley waits, which can strip patients of their dignity."
Theresa Fyffe, director of the Royal College of Nursing (RCN) in Scotland, said: "The RCN is calling for a more realistic target of 95% of patients being seen within four hours rather than the current 98%.
"This would give A&E staff the flexibility and time to deliver the personalised, quality care patients deserve."