• Mattia Bellan, Francesco Gavelli, Eyal Hayden, Filippo Patrucco, Daniele Soddu, Anita R Pedrinelli, Micol G Cittone, Eleonora Rizzi, Giuseppe F Casciaro, Veronica Vassia, Raffaella Landi, Mirta Menegatti, Maria L Gastaldello, Michela Beltrame, Emanuela Labella, Stelvio Tonello, Gian C Avanzi, Mario Pirisi, Luigi M Castello, and Pier P Sainaghi.
• Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, Italy - mattia.bellan@uniupo.it.
• Panminerva Med. 2020 Jun 16.

BackgroundThe 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.MethodsWe 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.ResultsThe 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.ConclusionsThe 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.

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