Continuous Increase in Both Waiting and Process Time in the Emergency Rooms of Abruzzo, Italy

A recent report by the Italian Ministry of Health showed that a high proportion of Emergency Department (ED) visits exceed the maximum recommended thresholds for both waiting time and overall length of stay. As no overall quantitative data are available on the magnitude, temporal evolution, and underlying drivers of ED performance from Southern Italian regions, we analyzed ED data from the Abruzzo region during the years 2017-2024, and evaluated potential predictors of prolonged waiting and process time.

Official, administrative data from all the regional EDs were collected, and information on personnel, location and organizational change was obtained through a dedicated survey. All analyses were stratified and/or adjusted by triage code, hospital, age and sex.

From 2017 to 2024, a total of 3,563,565 accesses were recorded in the 16 regional EDs. From 2021, waiting time for the first visit steadily and progressively increased, reaching an average of 78 min in 2024 (+56.0%), largely exceeding recommended thresholds. The most critical growth was observed for the most severe patients, as mean waiting time for yellow and red admissions peaked at 81 (+100%) and 39 (+290%) minutes (m) in 2024, respectively. The mean process time also substantially increased in post-pandemic years, especially for yellow (from 300 m to 476 m) and red codes (from 330 m to 607 m). The trend was similar for both genders, in all age-classes, and higher in larger hospitals. Multivariable analyses confirmed a significant increase in ED time over the years.

These findings indicate critical organizational and clinical issues in the regional emergency care system, requiring immediate action. The Regional Healthcare System recently tried to reduce ED overcrowding with specific plans, the impact of which requires urgent evaluation.