Distribution of targeted educational materials to families after they attend emergency or urgent care services with a child under 5 years-old in a non-urgent situation, in order to reduce future repeat non-urgent attendances

INTERVENTION: This study aims to test whether it is possible to reduce pressure on children’s emergency departments (called paediatric emergency departments or PEDs) and urgent care centres (UCCs). The aim is to do this by sending out targeted and behaviourally‐informed, written educational materials (referred to as the ‘educational bundle’) to the parents or carers of children under 5 years old after their child has recently attended PED or UCC, and whose health issues were non‐urgent and could likely have been dealt with elsewhere (either at home with advice or by a primary care service). The educational bundle consists of a: 1. Personalised cover letter – containing the child’s name and hand‐signed by a clinician 2. “How to help your unwell child” – 8‐page information booklet 3. A5 factsheet with information on how to identify serious childhood illness 4. NHS 111 Fridge magnet This study is a two‐arm randomised controlled trial at two research sites (St Mary’s Hospital PED and Northwick Park Hospital UCC). The unit of randomisation is the family, and the outcomes are also measured at the family‐level (i.e. the outcome is whether the family reattends the hospital non‐urgently). This is done to ensure that parents of siblings receive the same intervention at each attendance. Within 72 hours after the parents or carers have attended PED or UCC, a healthcare professional from the research team will identify them as being a non‐urgent attendance. The family will then be randomised into the intervention or control group. Those families allocated to the intervention group will be sent a personalised educational bundle in the post. Participants will receive no further intervention or contact from the research team unless they have indicated they wish to do so. The trial will run for 8 months from October 2017 to May 2018. Attendance data will be collected for 11 months from October 2017 until August 2018. Anonymised patient records will be analysed using linear regression analy CONDITION: Non‐urgent reattendance at paediatric emergency departments and urgent care centres ; Not Applicable PRIMARY OUTCOME: Whether the families reattend the hospital non‐urgently after an initial non‐urgent attendance at the same hospital. Attendance data will be collected for 11 months from October 2017 until August 2018. SECONDARY OUTCOME: Whether the families reattend the hospital non‐urgently after an initial non‐urgent attendance at the same hospital over a fixed period of time: within 30 days or 90 days. Attendance data will be collected for 11 months from October 2017 until August 2018. INCLUSION CRITERIA: 1. Parent and carers of children aged under 5 years old that attend St Mary's Hospital paediatric emergency department (PED) with a non‐urgent healthcare problem. To be defined as a non‐urgent attendance, at that visit the patient must: 1.1. Receive a triage score of 4 or 5 on the Manchester Triage System (this ranges from 1 (most severe) to 5 (least severe 1.2. Not have been admitted to the hospital 1.3. Not have received any medical tests (e.g. x‐rays or blood tests) 2. Parent and carers of children aged under 5 years old that attend Northwick Park urgent care centre (UCC) with a non‐urgent healthcare problem. To be defined as a non‐urgent attendance, at that visit the patient must: 2.1. Be streamed into the UCC, not PED 2.2. Not be triaged as ‘urgent’ at any point 2.3. Not be referred to a paediatric or other specialist at any point