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

Authors

  • Alessio Vedovetto,

    1. Clinic of Pediatric Onco-Hematology, A.O. Padova, Padova, Italy
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  • Nicola Soriani,

    1. Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy
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  • Emanuela Merlo,

    1. Department of Professional Training, ULS 8, Castelfranco Veneto, Italy
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  • Dario Gregori

    Corresponding author
    1. Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Via Loredan 18, Padova, Italy
    • Address correspondence to Prof. Dario Gregori, Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Via Loredan 18, Padova 35131, Italy; e-mail: dario.gregori@unipd.it.

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Abstract

Objective

To better understand the issue of inappropriate pediatric Emergency Department (ED) visits in Italy, including the impact of the last National Health System reform.

Study Design

A retrospective cohort study was conducted with five health care providers in the Veneto region (Italy) in a 2-year period (2010–2011). ED visits were considered “inappropriate” by evaluating both nursing triage and resource utilization, as addressed by the 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 percent) 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 (PCP) is not available.

Conclusion

The National Health System reform aims to improve efficiency, effectiveness, and costs by opening PCP offices 24 hours a day and 7 days a week. This study highlights the need for a deep reorganization of the Italian Primary Care System not only providing a larger time availability but also treating the parents' lack of education on children's health.

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