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Potentially avoidable emergency department attendance: interview study of patients' reasons for attendance
  1. S Agarwal1,
  2. J Banerjee2,3,
  3. R Baker1,
  4. S Conroy4,
  5. R Hsu5,6,
  6. A Rashid6,
  7. J Camosso-Stefinovic1,
  8. P Sinfield1,
  9. M Habiba4
  1. 1Department of Health Services, NIHR CLAHRC for LNR, University of Leicester, Leicester, UK
  2. 2Department of Emergency Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
  3. 3NHS Leicester Leicestershire and Rutland, Leicester, UK
  4. 4Cancer Studies, University of Leicester and Associate Medical Director, Leicestershire County and Rutland PCT, Leicester, UK
  5. 5Department of Medical and Social Care Education, University of Leicester, Leicester, UK
  6. 6Leicestershire County and Rutland PCT, Leicester, UK
  1. Correspondence to Shona Agarwal, NIHR CLAHRC for LNR, Department of Health Sciences, University of Leicester, 22-28 Princess Rd West, Leicester LE1 6TP, UK; sa144{at}


Objectives To explore the reasons for attendance at the emergency department (ED) by patients who could have been managed in an alternative service and the rate of acute admissions to one acute hospital.

Design Interview study.

Setting One acute hospital (University Hospitals of Leicester) in the East Midlands.

Participants 23 patients and/or their carers.

Methods A purposive sample of patients attending the ED and the linked urgent care centre was identified and recruited. Patients in the sample were approached by a clinician and a researcher and invited to take part in an interview. Patients of different ethnicities and from different age groups, arriving at the ED via different referral routes (self-referral, emergency ambulance, GP referral, out-of-hours services) and attending at different times of the day and night were included. The interviews were recorded and transcribed with the individuals' permission and analysed using the framework analysis approach.

Results Patients' anxiety or concern about the presenting problem, the range of services available to the ED and the perceived efficacy of these services, patients' perceptions of access to alternative services including general practice and lack of alternative pathways were factors that influenced the decision to use the ED.

Conclusions Access to general practice, anxiety about the presenting problem, awareness and perceptions of the efficacy of the services available in the ED and lack of alternative pathways are important predictors of attendance rates.

  • Admission avoidance
  • emergency care systems
  • emergency departments
  • primary care
  • general
  • fractures and dislocations
  • systems
  • accidental falls
  • acute medicine-other
  • paediatrics
  • paediatric emergency medicine
  • cost effectiveness
  • education

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  • Funding This study is part of a programme of research funded by the National Institute of Health Research (NIHR) which is being undertaken by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Leicestershire, Northamptonshire and Rutland (LNR). The views expressed in the paper do not necessarily reflect those of the Department of Health or the NIHR. The funder had no role in study design, collection, analysis, and interpretation of data and the writing of the article and the decision to submit it for publication. All the researchers had access to the data.

  • Competing interests MH is an employee of Leicestershire County and Rutland Trust, and JB and MH are employees of University Hospitals of Leicester Trust that might have an interest in the submitted work in the previous 3 years.

  • Patient consent A patient and carer consent form was designed by the team and was used to obtain consent.

  • Ethics approval The study was a service evaluation. NHS ethics committee approval was not required, but we sought and obtained approval from the Medical Directorate Safety, Effectiveness and Audit Committee at UHL.

  • Provenance and peer review Not commissioned; externally peer reviewed.