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When should you bring a child to hospital?

19th Dec 2017

There are obvious answers. Any child should go to an emergency department if they’ve been knocked unconscious or are struggling to breath. For less serious problems, like broken bones and infections, they can go to minor injuries units and urgent care centres.

However, the majority of children do not attend paediatric emergency departments (PED) because of potentially life-threatening problems like these. Non-urgent attendances at PED (i.e. attendances for illness that could have safely been treated elsewhere) have increased significantly in recent years. In England in 2013/14, almost 90% of PED attendances did not result in the child being admitted to the hospital.

The Behavioural Insights Team (BIT) and Connecting Care for Children (CC4C), with funding from the Health Foundation, are trying to understand what drives these non-urgent hospital attendances.  As part of the BLUEPRINTS study, we reviewed research on this topic, and interviewed parents and staff in two North West London hospitals.

We identified five key drivers of non-urgent hospital attendances:

  • Worry: Parents can feel great anxiety about their child’s health. Going to the PED can relieve this worry, and reassure themselves that they did “all that they could” to help their child.
  • Perceived advantages of PED: Parents often want to see a paediatrician rather than a GP. However, in many cases GPs are just as well equipped to diagnose and treat children with non-urgent illnesses.
  • Perception that other healthcare services are not suitable: Parents are often not aware of the other services available for minor illnesses (e.g. NHS 111, pharmacies, out-of-hours GPs), or, if they are aware, they do not come to mind at decision points in a period of stress. Instead, the PED comes quickly to mind as a place where are guaranteed access to healthcare.
  • Social influence: Parents sometimes attend PED because their family or friends told them to. In line with research showing the power of injunctive social norms, parents follow this advice because they want to be seen as good parents in the eyes of others.
  • Lack of confidence and low health literacy: Many parents are not sure how to tell when their child’s illness is serious. Unfortunately, hospital staff rarely have the time to improve this issue during ED visits. During our observations, we noticed that parents usually get only verbal (not written) advice about what they should do the next time their child is unwell – information that is unlikely to stay in their memory.

Using this information, the next stage of this project will involve designing a behavioural intervention. We want to help parents easily and reliably identify when their child is seriously unwell and needs hospital attention, and when they can probably be looked after at home.

In addition to supporting parents to manage their child’s health, this project could help reduce non-urgent hospital attendances, and in turn allow hospitals to spend more time treating the seriously unwell children who most need their help.

The full report Why do parents bring children with minor illness to emergency and urgent care departments? Literature review and report of fieldwork in North West London is published today by the Behavioural Insights Team.


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Dr Ben Holden

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Imperial College Healthcare NHS Trust