Which digital tools reduce avoidable ED attendances?

On 1st April 2026, NHS England wrote to ICB and trust chief executives with its planning priorities for 2026/27. The letter sets out urgent care scheduling and access reform aimed at reducing avoidable ED attendances, and it names the NHS App as the digital front door into the NHS for triage and navigation.

ICB footprints merged in the same month, so many commissioners are now planning across new geographies. Performance pressure has not eased. In September 2026, 74.4% of A&E attendees were admitted, transferred or discharged within four hours. The Medium Term Planning Framework asks every trust to maintain or improve to 82% by March 2027.

NHS 111 online: NHS 111 online launched in 2017 and the August 2026 triage data shows it completed 795,038 triages using the same NHS Pathways algorithm as the telephone service. Usage is established. The effect on emergency demand is less clear.

An NIHR-funded evaluation found that recommendations to attend an emergency or urgent care service rose by between 4.2% and 6.7% for every 1,000 online contacts, which points to a possible net increase in demand. The analysis measured recommendations, not what patients did next, and it covers the service's early years, so the picture may have moved.

The NHS App: More than 15.5 million distinct users logged into the NHS App in August 2026, and 29 million did so across the 12 months to September 2026, according to NHS England Digital. National policy places the App at the centre of the digital front door.

There is very little in the way of published analysis that links the app to fewer ED attendances. That absence is a gap in the public record. If you fund App-based triage in your footprint, ask for your local data.

Virtual wards: Two studies point in different directions. A 2023/24 evaluation of the South East region reviewed 22,000 step-up virtual ward admissions and associated them with lower rates of non-elective admission, at roughly one avoided admission for every 2.5 virtual ward admissions, as summarised in a UK Parliament briefing.

In August 2026, University of Sheffield researchers reported on 236,741 patients across four South Yorkshire hospitals. They found no consistent evidence, positive or negative, that virtual wards reduced admissions, shortened stays or lowered readmissions. The report suggests the services may have been too small to register across the wider hospital system, and its lead author cautions that data quality limits the results. Frailty virtual ward patients were also more likely to attend A&E or be readmitted within seven days of leaving the ward.

Please note that both studies measure admissions, not ED attendances. Any link to attendances is indirect.

Remote monitoring: Remote monitoring sits inside many virtual wards, and the same Parliament briefing describes emerging evidence that it can reduce admissions and readmissions. Most of the UK studies evaluate single services or pathways. Those studies show that monitoring is feasible and safe, and say less about attendances across a population.

In-department patient flow and pathway tracking: The fifth layer works on the other side of the door. Live tracking does not change how many people arrive, rather it changes how well a department sees, treats and records the people who do.

Three limits apply to every layer above:

• Digital exclusion: The NHS Confederation's digital exclusion index maps barriers to digital health services, including the NHS App, onto the new ICB footprints. Read your own footprint's score before you assume demand will shift.
• Displacement: An alternative that does not stick sends patients back to the department. Sheffield's frailty finding is one example. The NHS 111 online recommendation data is another.
• Measurement: Without consistent Emergency Care Data Set (ECDS) data at the department door, nobody can say whether an upstream layer worked.

Digital front doors can lower demand, but some people will still arrive: those without digital access, those with a clinical need, and those who choose the department anyway. The department has to handle them safely and report on them accurately, and the Medium Term Planning Framework expects agreed processes for seeing, treating and discharging non-admitted patients within four hours.

Access ED is a cloud-native emergency department information system built for that job. It tracks patients in real time, builds ECDS compliance into the record, and manages the patient journey from registration and triage through to discharge and national reporting. One tracker screen shows each patient's priority, location, assigned clinician, wait time and care status. Colour-coded allergy alerts and safeguarding flags appear at the point of care, and every action is written to a time-stamped audit trail. Access ED also supports pathway tracking for the emerging EEMAC same day discharge model.

Specifications: Access ED currently receives pre-arrival information from NHS 111 telephony, so a patient signposted to the department arrives already known. The open API connects NHS 111, ambulance services and e-Triage. Our software roadmap has the EEMAC same day discharge model in testing currently, for deployment in the near future, as well as NHS BaRS, 111 Online, and ambulance pre-arrival to be implemented in the months after.

University Hospitals Birmingham (UHB) shows what this looks like at scale. Access ED was developed with UHB's clinical teams over 13 years, and it now has more than 700 clinical users across the Queen Elizabeth, Heartlands, Good Hope and Solihull hospitals. Dean Croft, IT Project Manager at UHB, describes "a real measurable difference in data quality since implementing Access ED."

We have just released our Same Day Emergency Care (SDEC) module to UHB, who expressed a high priority for such support ahead of winter pressure to redress the gap between Access ED and their legacy PAS, where patients may not be part of a typical ED pathway. This means patients anywhere in the Trust can be managed on the SDEC pathway, meaning increased visibility and oversight as part of the patient journey.

UHB's experience speaks to what a department can know about the people who do arrive. That knowledge is what lets a commissioner judge the digital layers upstream.

Commissioners can take these to provider ED leads at the next urgent and emergency care board.

1. Is ECDS data complete and timely enough to show what changed after a digital pathway went live?
   If not, your evaluation of any upstream layer rests on guesswork.
2. When a patient arrives who was signposted elsewhere, who owns the handoff, and how is it recorded?
   A signpost that ends at the door loses the information you need.
3. How do you measure whether a digital layer reduced attendances, as opposed to moving them?
   Ask for the method, not just the headline figure.

Share this guide with your ED leads and put the three questions on your next board agenda. To see how Access ED supports the department side of this picture, book a demonstration.