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Emergency departments and minor illness: some behavioural insights
  1. Mando Watson1,
  2. Mitch Blair2
  1. 1Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
  2. 2Department of Paediatrics, Imperial College London, London, UK
  1. Correspondence to Dr Mando Watson, Department of Paediatrics, Imperial College Healthcare NHS Trust, London, W2 1NY, UK; mando.watson{at}

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The 1999 Report ‘Accident and Emergency Services for Children’ was published by a collaboration of several Royal Colleges and national organisations, and it was a major driver for accident and emergency departments (ED) to become more expertly child-focused. The paediatric emergency department (PED) provides an environment that is more suitable for young ages, shielding the child and family from the sights, sounds and smells of the adult ED, and staffed by nurses and doctors with specialist child health training.

Yet now, NHS emergency services are creaking under enormous and increasing demands placed on it by the public. In England, 40% of all ED attendances are non-urgent (60% in the case of children), where the unwell person could be self-managed at home. Accident and Emergency (A&E) attendance costs nearly £100 m in 2011–2012 with ED on average being 36% more than an equivalent general practice (GP) visit.

The waiting time target, introduced in 2004, meant that a patient would be seen, treated and sent on his/her way within 4 hours no matter how ill.

As a result, the PED became quite an attractive option for the worried parent of a child with a non-urgent ailment, who would be almost guaranteed a paediatric opinion within that time period. Maybe PED has become a victim of its own success?

So why do parents bring their children to the PED with minor illness, and what can be done to better understand the drivers and inform potential solutions so desired by policy makers?

A recent report by Holden and colleagues1 attempts to answer the questions. Holden reviews and …

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  • Competing interests MW is a clinical lead for Connecting Care for Children, a programme of work that supports new models of care. The programme collaborated with Ben Holden, the author of the report. MB is academic supervisor to Ben Holden.

  • Provenance and peer review Commissioned; internally peer reviewed.

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