Pattern of emergency department referral during the Covid-19 outbreak in Italy.

Bellan, Mattia; Gavelli, Francesco; Hayden, Eyal; Patrucco, Filippo; Soddu, Daniele; Pedrinelli, Anita R; Cittone, Micol G; Rizzi, Eleonora; Casciaro, Giuseppe F; Vassia, Veronica; Landi, Raffaella; Menegatti, Mirta; Gastaldello, Maria L; Beltrame, Michela; Labella, Emanuela; Tonello, Stelvio; Avanzi, Gian C; Pirisi, Mario; Castello, Luigi M; Sainaghi, Pier P

BACKGROUND The coronavirus disease (COVID-19) outbreak is putting the European National Health Systems under pressure. Interestingly, Emergency Department (ED) referrals for reasons other than Covid-19 seem to have declined steeply. In the present paper, we aimed to verify how the Covid-19 outbreak changed ED referral pattern. METHODS We retrospectively reviewed the clinical records of patients referred to the ED of a University Hospital in Northern Italy from 1st March to 13th April 2020. We compared the following data with those belonging to the same period in 2019: number of EDs accesses, rate of hospital admission, frequencies of the most common causes of ED referral, priority codes of access. RESULTS The number of ED referrals during the Covid-19 outbreak was markedly reduced when compared to the same period in 2019 (3059 vs. 5691;-46.3%). Conversely, the rate of hospital admission raised from 16.9% to 35.4% (p<0.0001), with a shift toward higher priority codes of ED admission. In 2020, we observed both a reduction of the number of patients referred for both traumatic (513, 16.8% vs. 1544, 27.1%; χ2=118.7, p<0.0001) and non-traumatic (4147 vs. 2546) conditions. Among the latter, suspected Covid-19 accounted for 1101 (43.2%) accesses. CONCLUSIONS The Covid-19 pandemic completely changed the pattern of ED referral in Italy, with a marked reduction of the accesses to the hospitals. This could be related to a limited exposure to traumas and to a common fear of being infected during EDs in-stay. This may limit the misuse of EDs for non- urgent conditions, but may also delay proper referrals for urgent conditions.