Defining Non-Urgent ED Attendance

A validated process based definition of non-urgent attendance previously published by one of the study authors was adapted for this study [6 (link)]. As with this original definition, our approach applied the definition to patients who attended a type 1 ED, as a first attendance, but who were subsequently identified as not receiving investigations, treatments or referral that required the facilities of a type 1 ED. For the purposes of this definition all follow up attendances, whether planned or unplanned were considered urgent. Attendances at single specialty emergency departments, or centres designed for non-emergency patients were not included in the analysis.
Following consultation with our expert steering group (including clinicians, NHS managers and patient representatives) lists of investigations and treatments that did not require the facilities of a fully staffed ED and that could routinely be provided in a non-emergency care setting, such as primary care, were identified. The treatment, investigation and disposal HES codes taken as indicating non-urgent ED attendance are shown in Table 1 below.
Our definition of non-urgent attendance was therefore developed as follows:
This could be summarised as identifying “first attendance with some recorded treatments or investigations all of which may have reasonably been provided in a non-emergency care setting, followed by discharge home or to GP care.”