The Burden of Inappropriate Emergency Department Pediatric Visits: Why Italy Needs an Urgent Reform.

Objective: To better understanding the issue of inappropriate pediatric Emergency Department visits in Italy, including the impact of the last National Health System reform. Study design: A retrospective cohort study was conducted with 5 health care providers in Veneto Region (Italy) in a 2 years period (2010-2011). ED visits were considered “inappropriate” evaluating both nursing triage and resource utilization, as addressed by Italian Ministry of Health in 2007. Factors associated with inappropriate ED visits were identified. The cost of each visit was calculated. Principal findings: In total, 134,358 ED visits with 455,650 performed procedures were recorded in the 2-year period, of these, 76,680 (57.1%) were considered inappropriate ED visits. Patients likely to make inappropriate ED visits were younger, female, visiting the ED during night or holiday, when the Primary Care Provider is not available. Conclusion: The National Health System reform aims to improve efficiency, effectiveness and costs by opening PCP offices 24h a day and 7 days a week. This study highlights the need for a deep reorganization of Italian Primary Care System not only providing a larger time availability, but also treating the parents’ lack of education on children’s health.