The burden of inappropriate emergency department pediatric visits: why Italy needs an urgent reform.
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Clinic of Pediatric Onco-Hematology, A.O. Padova, Padova, Italy.
Alessio
A
Vedovetto
Nicola
N
Soriani
Emanuela
E
Merlo
Dario
D
Gregori
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D018166:Health Care Reform; D005102:Health Expenditures; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D009313:National Health Programs; D016017:Odds Ratio; D012189:Retrospective Studies; D014218:Triage
Nonurgent; health expenditure; inappropriate; pediatric emergency department; reorganization