ER access by non-EU citizens between 2000 and 2014 in a large teaching hospital of Rome, Italy

Background Lack of information about the national health system and the status of illegal immigrant can make difficult for migrants from non-EU countries to access primary care, leading to misuse of emergency room (ER). This study investigated non-EU citizens’ (non-EU) accesses between January 2001 and September 2014 to the ER of the ‘‘Umberto I’’ teaching hospital of Rome, Italy. Methods Patients’ accesses to ER, triage codes, hospitalizations, mortality and diagnoses of Italians and non-EUs were described. Incidence rate ratio (IRR) and 95% CI for the non-EUs of being assigned a white code at triage and of hospitalization after ER access compared to the Italians were estimated through Poisson regression. Results Of the 1,934,431 people that accessed the ER between 2000 and 2014, 266,213 were strangers. Non-EUs citizens increased from 6.6% to 11.5% during this period. They showed a higher rate of white codes than the Italians (19.3% vs 16.7%) and a lower rate of yellow and red codes. Poisson regression showed that non-EUs are more likely to be assigned a white code than the Italians (IRR: 1.17; 95% CI: 1.16-1.19; p < 0.001). Non-EUs left the ER without authorization more frequently than Italians and experienced also a lower rate of hospitalization (13.9% vs 8.0% and 14.3% vs 17.8%, respectively). Poisson regression confirmed these results showing a lower risk for non-EUs to be hospitalized (IRR: 0.98; 95% CI: 0.96-0.99; p < 0.001). The ER death rate was low and stationary during the period and twofold higher in Italians than in non- EUs (0.14% vs 0.07%). Respiratory, genitourinary and obstetrical/gynaecological diseases were more frequently diagnosed in non-EUs (8%, 3.4% and 9.1%, respectively) than in Italians (6.3%, 2.7% and 3.8%, respectively). Conclusions These results highlighted a propensity for the non-EUs to access the ER mostly for non-urgent events. This could partly be an effect of the lack of filters in access to care, usually carried out by the primary care. Key messages: Non-EU citizens have higher rate of inappropriate access to emergency rooms, as showed by the rate of white codes, hospitalization and mortality There is a need for filters other than the usual able to appropriately route this non-EU population and to address its specific health needs