- High demand for emergency and urgent care services is putting pressure on NHS organisations and staff. An increase in the attendances of children under 5 years-old with non-urgent, minor problems contributes to this demand.
- Findings from the literature and our own fieldwork (observations and interviews) suggest delivering targeted education on how to manage childhood illness could influence a parents’ decision to reattend at hospital.
- We will co-design with families an intervention to try to address these issues. Specifically, we will distribute targeted educational materials to families after they attend emergency or urgent care with a child under 5 years old in a non-urgent situation, in order to reduce future repeat non-urgent attendances.
- The educational materials will use behavioural insights to support parents by giving them the knowledge and confidence to manage minor childhood illnesses at home.
- Led by The Behavioural Insights Team, in partnership with the Connecting Care for Children team from Imperial College Healthcare NHS Trust.
- Completion date: Summer 2018.
There is currently high demand for emergency and urgent care services, putting pressure on NHS trusts and staff. NHS England’s Urgent and Emergency Care Report states that 40% of patients attending emergency departments are discharged requiring no treatment at all. Furthermore, a National Audit Office report notes that approximately 20% of admissions are for known conditions which could be managed effectively by primary, community or social care services.
Many of these non-urgent attenders are young children presenting with symptoms of minor illness. In 2013/14, almost 90% of paediatric emergency department (PED) attendances did not result in the child being admitted to the hospital. The number of PED attendances in England has grown in recent years, rising from 3.9 million in 2008/09 to 5.1 million in 2014/15. This increase appears to be driven by factors such as parental attitudes and expectations around the management of sick children; issues with access to primary care; and the erosion of traditional support networks.
Our fieldwork indicated there is an opportunity to reduce unnecessary PED and urgent care centre (UCC) attendances by giving parents the knowledge and confidence to manage minor childhood illnesses at home. During our interviews with parents, many expressed a desire for written information and healthcare education after or at the point of discharge, but this was rarely observed in PED and UCC.
This project will use insights from behavioural science to design a new intervention for families that have attended PED or UCC with a non-urgent healthcare concern. This will be co-designed - together with parents and carers – and aims to educate families that have attended non-urgently on how to identify serious childhood illness, manage common childhood health conditions at home, and signpost them to the most appropriate healthcare services.
The intervention will be trialled at two hospital sites: St Mary’s Hospital and Northwick Park Hospital, through a two-arm randomised control trial. Half of the non-urgent attendances will receive the educational bundle after discharge.
Through the Connecting Care for Children programme (CC4C) the research team will also explore opportunities in community and primary care settings for influencing parental decision making around childhood illness.
Note: this project was previously titled 'FeveRED: Re-engineering A&E discharge for children with fever' but due to a change in the scope of the project it has been renamed
'BLUEPRINTS: Does targeted parental education reduce non-urgent paediatric emergency department and urgent care centre reattendance?'
BLUEPRINTS is an acronym for: Behaviour and learning underpinning emergency paediatric reattendance in non-urgent situations.
For more information about this project, please contact: