Factors associated with avoidable non-urgent emergency department visits in South Tyrol (Italy): a multicentre...

Emergency departments (EDs) suffer from crowding due to patients with low urgency, whose treatment is often inappropriate. This study aimed to describe the proportion of avoidable, non-urgent ED visits and explore the factors associated with these visits in Italy.

This multicentre cross-sectional study was conducted in the EDs of seven public hospitals in the South Tyrolean Health Service in the northern Italian Province of Bolzano-Bozen; Data were collected in each ED over two full consecutive weeks (24 h, weekdays, and weekends) between September 1, 2024, and November 30, 2024. Data on 574 adult patients (≥ 18 years) with clinical conditions that were triaged as "non-urgent" (i.e. Manchester Triage System priority level 'blue' or 'green'), and who consented to participate were analysed. Descriptive and logistic regression analyses were performed to explore the factors associated with avoidable non-urgent ED visits.

Of the 574 non-urgent patients attending the ED, 288 (50.2%) were categorised by physicians and nurses as avoidable and 286 (49.8%) as unavoidable. Only 39.0% (n = 215) had been in contact with their GP before attending the ED, either by phone or by having a visit. The main reasons for attending the ED were better diagnostic options (45.1%, n = 259), positive past experiences (34.1%, n = 196), and faster access to specialist consultation (30.7%, n = 176). Patients living within 10 km of the ED (OR = 1.82, 95% CI: 1.20-2.77, P = 0.005), who presented with general and unspecific symptoms (OR = 2.29, 95% CI: 1.25-4.30, P = 0.008), and who were assigned a blue code, were more likely to be assessed as avoidable ED visits by healthcare professionals.

This study shows the proportion and characteristics of avoidable non-urgent ED visits. As the current primary care structures may not fully match contemporary expectations of accessibility, diagnostic reassurance, and patient-centred responsiveness, system-level interventions to reduce avoidable ED use must address reforms in primary care. Considering the structural reforms in Italy's primary care system and the establishment of community health centres, our findings provide a valuable evidence base for guiding local implementation strategies aimed at enhancing primary care responsiveness and reducing unnecessary ED utilisation.