Effect of COVID-19 and other determinants on the reduction of non-urgent emergency department access in North-East Italy: does supply affect demand?

Abstract

This study examines the impact of the COVID-19 pandemic on non-urgent emergency department (ED) utilizzation in Friuli Venezia Giulia, Italy, comparing the pre-COVID (2019) and COVID (2021) periods. A retrospective observational analysis at the municipal level assessed admission rates of non-urgent patients, identified by "white code" triage. Variables analyzed included driving time to the nearest ED, altitude, and the effect of closing first intervention points. Results showed a significant 31% reduction in non-urgent ED visits from 2019 to 2021, with a mean reduction of 37.8% in municipalities affected by ED closures. A multivariate linear model showed that increased driving time and higher pre-pandemic admission rates were both associated with greater reductions in access, while altitude showed a positive correlation with access rates. The findings suggest that service supply limitations, such as ED closures, significantly reduce non-urgent ED utilization, especially in lowland and hilly areas, but less so in mountainous regions.