Targeted Letters to Reduce Avoidable Emergency Department Attendances

Study Overview
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Brief Summary
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The study aims to test whether it is possible to reduce pressure on Emergency Departments by sending a personal feedback letter to people who have recently attended an Emergency Department and whose health issues could likely have been dealt with elsewhere. These attendances clearly have many causes. However, it is likely that some attendances are due to behavioural factors - in other words, the various ways in which users interact with services. This study focuses on one particular behavioural factor: lack of feedback to users making avoidable visits. The study will take place in collaboration with an NHS hospital trust. Each week during the trial, the hospital trust will identify those Emergency Department attendances in the last seven days which, according to clinical judgement, could have been dealt with elsewhere. Patients will then be randomly selected to receive a letter containing information on alternative healthcare options for non-emergency health concerns. Patient records will be analysed to determine whether the patients who received the letter are less likely to make an avoidable repeat visit to the Emergency Department in the future, compared with patients who received no letter.

Official Title
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Targeted Letters to Reduce Avoidable Emergency Department Attendances

Conditions
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Avoidable Emergency Department Attendances

Intervention / Treatment
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* Behavioral: Letter


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults who attended a participating Emergency Department during the trial period and whose attendance was codes as 'No Investigation No Significant Treatment' Exclusion Criteria: Children under the age of 18 All departments and hospitals other than participating Emergency Departments.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Letter<br>Patients receive a letter containing information on alternative healthcare options for non-emergency health concerns. | Behavioral: Letter<br>* Patients receive an information letter following an avoidable visit to the Emergency Department.<br>|
| No Intervention: No letter<br>Patients receive no letter (this is the usual care). | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of avoidable Emergency Department re-attendances (Attendances are classified as avoidable using the 'No Investigation No Significant Treatment' code.) | Attendances are classified as avoidable using the 'No Investigation No Significant Treatment' code. | Measured at 4 months after previous attendance |