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Reducing repeat paediatric emergency department attendance for non-urgent care: a systematic review of the effectiveness of interventions
  1. Brenda Agyeiwaa Poku1,
  2. Pippa Hemingway2
  1. 1 Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
  2. 2 School of Health Sciences, University of Nottingham School of Health Sciences, Nottingham, UK
  1. Correspondence to Ms. Brenda Agyeiwaa Poku; brenda.poku{at}


Objective Non-urgent paediatric ED (PED) visits appear to contribute a large portion to the growing use of EDs globally. Several interventions have tried to curb repeated non-urgent attendances, but no systematic review of their effectiveness exists. This review examines the effectiveness of interventions designed to reduce subsequent non-urgent PED visits after a non-urgent attendance.

Method A systematic review design. A systematic search of four databases and key journals was conducted from their inception to November 2018. Experimental studies, involving children aged 0–18 years presenting to an ED for non-urgent care, which assessed the effectiveness of interventions on subsequent non-urgent attendance were considered.

Results 2120 studies were identified. Six studies, including four randomised controlled trials (RCTs) and two quasi-experimental, were included. Studies were of moderate quality methodologically. All studies originated from the USA and involved informational and/or follow-up support interventions. Only two RCTs demonstrated the longest duration of intervention effects on reducing subsequent non-urgent PED attendance. These studies identified participants retrospectively after ED evaluation. The RCT with the largest number of participants involved follow-up support by primary physicians. Meta-analysis was impractical due to wide heterogeneity of the interventions.

Conclusions There is inconclusive evidence to support any intervention aimed at reducing subsequent non-urgent PED visits following a non-urgent attendance. The long-term impact of interventions is limited, although the effect may be maximised if delivered by primary care providers in children identified after their ED attendance. However, further research is required to evaluate the impact of any such strategies in settings outside the USA.

  • repeat attendance
  • children
  • interventions
  • emergency department
  • minor illness
  • non-urgent care
  • paediatric
  • systematic review

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  • Contributors All authors made substantial contributions towards the conception and design, analysis and interpretation of data and drafting and critical revisions of the manuscript.

  • Funding The review was undertaken as part of the first author’s MSc study, which was jointly funded by the University of Nottingham and the Commonwealth Scholarships and Fellowship Plan.

  • Competing interests None declared.

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

  • Patient consent for publication Not required.