A randomised controlled trial to test the effect of targeted parental information on non-urgent paediatric emergency department reattendance
File(s)
Author(s)
Holden, Benjamin
Type
Thesis
Abstract
Background:
Year upon year the pressure on emergency and urgent care across the National Health Service (NHS) in England has increased. A rise in non-urgent attendance of young children at paediatric emergency departments (PEDs) has contributed to this pressure.
Aims:
The three key aims of this study were:
(i) To identify the reasons for non-urgent attendance at PED as described in the published
literature.
(ii) To develop a targeted intervention that aimed to reduce non-urgent reattendance at
PED.
(iii) To evaluate the effect of the targeted intervention on non-urgent reattendance at PED
using a randomised controlled trial.
Methodology:
Research activities were mapped to MRC guidance on “Developing and evaluating complex interventions” (Craig et al., 2008). A narrative review identified the reasons that children attend PED with non-urgent health concerns. A systematic review identified interventions that had attempted to address non-urgent PED reattendance. Literature review findings and feedback from stakeholders (including families with young children) were used to generate a theoretical mechanism for reducing non-urgent PED reattendance. The evidence base, a theoretical framework and caregiver and stakeholder involvement were combined with an awareness of the population context and the application of behavioural insights to develop the educational bundle. This educational bundle was evaluated using a multicentre, two- armed RCT with balanced randomisation (1:1).
Results:
Overall, the educational bundle did not have a detectable effect on non-urgent PED reattendance. The educational bundle may have reduced the proportion of non-urgent reattendances for families that initially attended with male children (but not for those that initially attended with female children).
Conclusion:
Although no effect was detected, an informative and evidence-based intervention was successfully developed in collaboration with caregivers and healthcare professionals. This thesis demonstrates the utility of the MRC Framework, patient and public involvement and the application of behavioural insights in response to a healthcare system challenge.
Year upon year the pressure on emergency and urgent care across the National Health Service (NHS) in England has increased. A rise in non-urgent attendance of young children at paediatric emergency departments (PEDs) has contributed to this pressure.
Aims:
The three key aims of this study were:
(i) To identify the reasons for non-urgent attendance at PED as described in the published
literature.
(ii) To develop a targeted intervention that aimed to reduce non-urgent reattendance at
PED.
(iii) To evaluate the effect of the targeted intervention on non-urgent reattendance at PED
using a randomised controlled trial.
Methodology:
Research activities were mapped to MRC guidance on “Developing and evaluating complex interventions” (Craig et al., 2008). A narrative review identified the reasons that children attend PED with non-urgent health concerns. A systematic review identified interventions that had attempted to address non-urgent PED reattendance. Literature review findings and feedback from stakeholders (including families with young children) were used to generate a theoretical mechanism for reducing non-urgent PED reattendance. The evidence base, a theoretical framework and caregiver and stakeholder involvement were combined with an awareness of the population context and the application of behavioural insights to develop the educational bundle. This educational bundle was evaluated using a multicentre, two- armed RCT with balanced randomisation (1:1).
Results:
Overall, the educational bundle did not have a detectable effect on non-urgent PED reattendance. The educational bundle may have reduced the proportion of non-urgent reattendances for families that initially attended with male children (but not for those that initially attended with female children).
Conclusion:
Although no effect was detected, an informative and evidence-based intervention was successfully developed in collaboration with caregivers and healthcare professionals. This thesis demonstrates the utility of the MRC Framework, patient and public involvement and the application of behavioural insights in response to a healthcare system challenge.
Version
Open Access
Date Issued
2020-07
Date Awarded
2021-02
Copyright Statement
Creative Commons Attribution NonCommercial Licence
License URL
Advisor
Blair, Mitchel
Maconochie, Ian
Sponsor
Health Foundation (Great Britain)
Publisher Department
School of Public Health
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Medicine (Research) MD (Res)