Care accessibility and reasons for non-urgent emergency department visits in South Tyrol (Italy): protocol of the multicentre cross-sectional CARES study.

Introduction: Emergency departments (EDs) suffer from crowding due to patients with low urgency whose treatment is often inappropriate in many cases. Crowding in the ED may indicate inefficiencies in the primary care infrastructure. According to the literature, it is associated with individual and system-related factors, such as younger age, convenience of visiting the ED and a negative perception of care outside the hospital. However, patients' motives driving decision-making for non-urgent visits to the ED in this post-pandemic period require further exploration. Therefore, this study aims to describe the proportion of potentially avoidable, non-urgent ED visits and to explore the associations between socio-demographic and clinical characteristics, patients' motives, and potentially avoidable, non-urgent visits to the ED.

Methods and analysis: This multicentre cross-sectional study will be conducted in the ED of seven public hospitals in the South Tyrolean Health Service in the northern Italian Province of Bolzano-Bozen. A consecutive sample of 1000 adult patients (≥18 years) with clinical conditions that are triaged as 'non-urgent' (ie, Manchester Triage System priority level 'blue' or 'green') and consent to participate in the study will be included. Data will be collected in each ED over two full working weeks (24 hours, weekdays and weekends) between 1 September 2024 and 30 November 2024. For each patient, triage nurses and medical doctors will fill out a data collection sheet, including the triage code, diagnosis at discharge and avoidability of the ED visit. Patients will be surveyed using a structured questionnaire with standardised instruments (eg, the Patient Activation Measure and Mental Health Inventory) and self-developed items (eg, motives for ED visits and previous use of community care services). Data analysis will involve descriptive and inferential analyses (ie, χ² tests) to determine group differences. Multivariate multilevel modelling will be applied to explore the associations between individual, system and cultural factors and potentially avoidable, non-urgent visits.

Ethics and dissemination: Ethical approval for this study was obtained from the Medical Ethics Committee of the South Tyrolean Health Service (Nr. 41-2024). The results will be published in relevant scientific journals and communicated to the public and relevant institutions through dissemination activities, including press releases and stakeholder meetings. The findings will inform recommendations aimed at refining health policies and optimising access to primary and emergency care services.

Registration details: ISRCTN registry (ISRCTN17355506).