Objective. To better understand the issue of inappropriate pediatric Emergency Department (ED) visits in Italy, including the impact of the last National Health System reform. Study Design. A retrospective cohort study was conducted with five health care providers in the Veneto region (Italy) in a 2-year period (2010)(2011). ED visits were considered "inappropriate" by evaluating both nursing triage and resource utilization, as addressed by the Italian Ministry of Health in 2007. Factors associated with inappropriate ED visits were identified. The cost of each visit was calculated. Principal Findings. In total, 134,358 ED visits with 455,650 performed procedures were recorded in the 2-year period; of these, 76,680 (57.1 percent) were considered inappropriate ED visits. Patients likely to make inappropriate ED visits were younger, female, visiting the ED during night or holiday, when the primary care provider (PCP) is not available. Conclusion. The National Health System reform aims to improve efficiency, effectiveness, and costs by opening PCP offices 24 hours a day and 7 days a week. This study highlights the need for a deep reorganization of the Italian Primary Care System not only providing a larger time availability but also treating the parents' lack of education on children's health. Key Words. Nonurgent, inappropriate, pediatric emergency department, health expenditure, reorganizationThe aim of the Emergency Department (ED) is to address emergent or urgent health problems, whose treatment has to be immediate. ED utilization is continuously rising (Ben-Isaac et al. 2010): in the United States the number of visits increased from 96 million in 1995 to 119 million in 2006. Patients from 0 to 18 years of age account for about 25 percent of the total number of ED visits (Mistry et al. 2006). The high level of utilization of ED services is overwhelmed by an inappropriate and heavy access for nonurgent conditions. The