Impact of tourists on emergency department in a high-tourism alpin area: An observational study.

ABSTRACT

BACKGROUND: The exponential growth of tourism worldwide could have consequences for healthcare services in tourist locations. The impact of the tourist population on access to emergency departments (EDs) is currently unknown. AIM: To describe the characteristics of tourist access in an ED of an alpine tourist area in a period prior to the COVID-19 pandemic. METHODS: All patients evaluated at the ED of the Merano Hospital from January 1, 2017, to December 31, 2019, were considered and divided into two study groups locals and tourists. Analyses were conducted to assess the impact of tourists in terms of weighted ED admissions and differences in admission characteristics. Finally, for tourist patients only, an analysis of severity according to their type of healthcare system of provenance was performed. RESULTS: A total of 208,875 ED presentations were considered, of which 90.7% (189,406) were by local patients and 9.3% (19,469) were by tourists. The median ED admission rate was 1.65 admissions per 1000 overnight stays for locals versus 0.90 admissions per 1000 overnight stays for tourists. The time series analysis revealed a greater seasonal variation in accesses by tourists than by resident patients. A higher proportion of accesses with a severe code was found among tourist patients, while the local population exhibited a higher proportion of patients with a non-urgent code. In the tourist population, patients from a country with a free-market healthcare system had a higher number of ED presentations for severe conditions or that required hospitalisation than tourists from countries with Bismarck or Beveridge healthcare systems. CONCLUSIONS: The tourist population can have an important impact on EDs in high-impact tourist areas. The seasonality of the tourist population indicates the need for health policies that focus on educating the tourist population on the correct use of the ED.