Explore the vast range of titles available.

ObjectiveWe aimed to audit the extent to which care offered to paediatric patients in our emergency department met RCEM and RCPCH, Facing the Future standards1-3 in order to improve the quality of management.MethodsWe undertook retrospective electronic case note review for 82 children presenting to the emergency department in a 24 hour period to look at time to triage, recording of vital signs and pain score, the escalation for those scoring ≥3 on local PEWS score with repeat observations in 60 mins, time to treat and length of stay in the department. Interventions were implemented including multidisciplinary teaching, visual aids around the PED, targets for triage, doctor assessment and decision making for admission or discharge and reaudited 6 months later for 85 children in a 24hour period.ResultsAll children had a pain score recorded at triage There was an improvement by 21% for documentation of visual assessment of children on presentation. Mean time to triage improved by 22 minutes. There was an improvement by 37% of complete local PEWs scores being taken and their accuracy. The escalation and documentation of children scoring ≥3 remained at 25% with their observations being repeated within 60 mins. There was improvement by 8% to 94% for children having their observations repeated within 4 hrs whilst in the department and in length of stay. Table 1 demonstrates the triage time improvements. Length of stay, LOS times are shown in table 2.Abstract 7911 Table 1Triage timeAbstract 7911 Table 2Length of stay (LOS) in PEDConclusionFollowing multidisciplinary work with nursing staff, doctors and front door team there were significant improvements in time to triage and accuracy of the PEWS calculation. There was improved use of clinical spaces including the children’s observation unit, short stay ward and ward to reduce the LOS in the PED.Further work is required on the escalation of patients to senior clinicians and ensure documentation of repeat PEWs in a timely manner. The ‘hello nurse’ consultation which acts as the initial visual assessment with all patients needs to be better documented. Ongoing work is needed with specialties to further reduce LOS.ReferencesRCEM improving quality indicators and system metrics for Emergency Departments in England, 2019.RCPCH Triage in Paediatric Emergency Department, facing the future standards for children in emergency care settings June 2018.RCPCH Triage in Paediatric Emergency Department, facing the future standards for children in emergency care settings supplementary Advice Mar 2022

ObjectiveTo assess variation in current practice of initial health assessments (IHAs) for unaccompanied asylum-seeking children (UASC) across England.DesignCross-sectional survey.Main outcomes measuresType of routine assessment carried out, threshold to specialist referrals and facilities available to complete IHA.ResultsEighty-six health professionals responded across England; 47% had received training in UASC IHA and 33% in UASC mental health issues. The majority (80%) of IHAs were conducted with translator support and 7% of participants reported Child and Adolescent Mental Health Services (CAMHS) input. Around half of clinicians (53%) performed tuberculosis and bloodborne virus screening for all UASC, while other infectious diseases (IDs) screening was symptom and risk factor dependent. Overall, 14% of clinicians routinely comment on age assessment and 76% share the IHA report and health plan with UASC. The time allocated for assessment range between 30 and 90 min.ConclusionThere is significant variation in practice around UASC IHAs across England, notably around CAMHS input, time allocated, translation facilities and ID screening. The results suggest that, an increase in resources available for UASC teams, improved access to specialist services and further training on UASC health are all needed. Guidance that aims to set a best practice framework for UASC IHA delivery such as a ‘one-stop shop’ model would help to standardise UASC IHA across the country.

Why did you do this work?In late 2022, there was an outbreak of Group A Streptococcus (GAS) infections in the UK that led to an increase in associated mortality, particularly amongst children.1 This received widespread media attention and led to an increased number of unscheduled emergency care presentations.2 Despite fever and sore throat being a common cause of emergency department (ED) attendance, little is known regarding the expectations of parents for these visits, particularly at a time of a well-publicised disease outbreak.3 We designed a qualitative study to explore parental expectations when attending the ED with a child presenting with fever and sore throat.What did you do?This study was run in conjunction with the introduction of a Point of Care test (POCT) for GAS between January and April 2023. Children aged between 3-15 years who presented to ED with fever plus any of reported sore throat, tonsillar exudate, or severe tonsillar inflammation were eligible to participate in the study, and their accompanying parent/guardian was asked to complete a paper survey. Participants were asked what they were hoping to gain from their attendance by selecting all options that applied from a set of seven suggestions, with blank space for free text provided for any answer not included within the given options.What did you find?30 parents participated in the study. The mean number of expectations given by each participant was 3. 80% of participants expected a medical review for their child, with 30% expecting advice and 43% wanting reassurance. Only 63% of parents were hoping to gain a diagnosis for their child’s illness and 37% expected blood tests to be taken. The proportion of parents that expected an antibiotic prescription was 27%. Just 20% were hoping to gain more information on GAS or scarlet fever.What does it mean?Our study found that parental expectations for ED attendances are often multi-factorial. Parents felt well informed regarding the GAS outbreak, with only 20% hoping to gain more information. Despite the widespread media coverage and the change in national guidance to lower the threshold for antibiotics, only 27% of parents expected an antibiotic prescription, whereas a greater proportion hoped for reassurance and advice. Gaining an insight into parental expectations of healthcare encounters is crucial in providing a safe, patient-centered service. We believe this can also contribute to reducing repeat attendances, which is of particular importance during a time of increased service pressure. Acknowledging and understanding these expectations can aid trust building and more effective communication between healthcare providers and families, ultimately improving the standard of care we can provide to children and young people.ReferencesJain N, Lansiaux E, Reinis A. Group A streptococcal (GAS) infections amongst children in Europe: taming the rising tide. New Microbes New Infect. 2022 Dec 15;51:101071. doi: 10.1016/j.nmni.2022.101071. PMID: 36593885; PMCID: PMC9803947.https://www.bbc.co.uk/news/health-63860028 (accessed 13.12.22)Leigh S, Robinson J, Yeung S, et al. Arch. Dis. Child. Epub. doi:10.1136/archdischild-2019-318209https://www.england.nhs.uk/wp-content/uploads/2022/12/PRN00058-group-a-streptococcus-in-children-interim-clinical-guidance-december-2022.pdf (accessed 13.12.22)

BackgroundPaediatric emergency departments have seen reduced attendance during the COVID-19 pandemic. Late paediatric presentations may lead to severe illness and even death. Maintaining provision of healthcare through a pandemic is essential. This qualitative study aims to identify changing care-seeking behaviours in child health during the pandemic and ascertain parental views around barriers to care.MethodsSemistructured interviews were conducted with caregivers of children accessing acute paediatric services in a hospital in North-West London. Thematic content analysis was used to derive themes from the data, using a deductive approach.ResultsFrom interviews with 15 caregivers an understanding was gained of care-seeking behaviours during the pandemic. Themes identified were; influencers of decision to seek care, experience of primary care, other perceived barriers, experiences of secondary care, advice to others following lived experience. Where delays in decision to seek care occurred this was influenced predominantly by fear, driven by community perception and experience and media portrayal. Delays in reaching care were focused on access to primary care and availability of services. Caregivers were happy with the quality of care received in secondary care and would advise friends to seek care without hesitation, not to allow fear to delay them.ConclusionA pandemic involving a novel virus is always a challenging prospect in terms of organisation of healthcare provision. This study has highlighted parental perspectives around access to care and care-seeking behaviours which can inform us how to better improve service functioning during such a pandemic and beyond into the recovery period.

Why did you do this work?The RCPCH’s ‘Facing the Future: Standards for Children in Emergency Care Settings’ emphasises the vital role of paediatric emergency departments (PED) in ensuring the safe discharge of children. Safety netting advice, which provides clear instructions on when and how to seek further medical attention, is critical for patient safety, particularly amidst the diagnostic uncertainties commonly faced in paediatric emergency care. This quality improvement project (QIP) aimed to evaluate current safety netting practices to identify areas for improvement.What did you do?Following the PDSA cycle framework, the ‘Plan’ was to perform a QIP to evaluate safety netting practices at a London District General Hospital PED. In the ‘Do’ phase, we assessed compliance with RCPCH Standard 24 by reviewing whether safety netting advice was documented in discharge summaries. Retrospective data was collected on 83 patients seen on January 15, 2024, followed by a re-audit of 85 patients on July 18, 2024. An anonymous survey (July 15 to August 20, 2024) gathered parent feedback on the advice provided. In the ‘Study’ phase, we analysed compliance rates and survey results. In the ‘Act’ phase, findings were presented at the local clinical governance meeting, standardised safety netting resources developed, and staff training provided. A second PDSA cycle is currently underway to evaluate the new interventions.What did you find?Compliance with the RCPCH safety netting standards improved from 71.1% in January to 87% by July 2024. The January discharge summaries showed that only 18.6% of patients received safety netting leaflets, with 13.6% directed to Healthier Together. Following this, we actively promoted the use of Healthier Together for safety netting advice. The subsequent parent satisfaction survey results showed that 91.3% of parents felt confident managing their child’s health post-discharge, reported receiving clear advice on recognising concerning symptoms and knew when to return to PED. However, 34.8% of respondents were non-English speakers, underscoring the need for multilingual resources, as only 87% felt they were directed to materials in their preferred language.What does it mean?This QIP highlights the importance of structured safety netting in paediatric emergency care. Although compliance has improved, gaps in resource distribution and accessibility remain. Parents provided positive feedback regarding the Healthier Together resource, highlighting its effectiveness. By implementing standardised protocols and focusing on tailored multilingual resources, we can enhance patient safety and better support families in managing their child’s health post-discharge. A second PDSA cycle is ongoing to evaluate the effectiveness of these interventions.ReferencesRCPCH. (2021). Facing the Future: Standards for Children in Emergency Care Settings. Royal College of Paediatrics and Child Health.NHS. (2020). Healthier Together: Guidance for Parents. NHS England.

Why did you do this work?The RCPCH’s ‘Facing the Future: Standards for Children in Emergency Care Settings’ emphasises the vital role of paediatric emergency departments (PED) in ensuring the safe discharge of children. Safety netting advice, which provides clear instructions on when and how to seek further medical attention, is critical for patient safety, particularly amidst the diagnostic uncertainties commonly faced in paediatric emergency care. This quality improvement project (QIP) aimed to evaluate current safety netting practices to identify areas for improvement.What did you do?Following the PDSA cycle framework, the ‘Plan’ was to perform a QIP to evaluate safety netting practices at a London District General Hospital PED. In the ‘Do’ phase, we assessed compliance with RCPCH Standard 24 by reviewing whether safety netting advice was documented in discharge summaries. Retrospective data was collected on 83 patients seen on January 15, 2024, followed by a re-audit of 85 patients on July 18, 2024. An anonymous survey (July 15 to August 20, 2024) gathered parent feedback on the advice provided. In the ‘Study’ phase, we analysed compliance rates and survey results. In the ‘Act’ phase, findings were presented at the local clinical governance meeting, standardised safety netting resources developed, and staff training provided. A second PDSA cycle is currently underway to evaluate the new interventions.What did you find?Compliance with the RCPCH safety netting standards improved from 71.1% in January to 87% by July 2024. The January discharge summaries showed that only 18.6% of patients received safety netting leaflets, with 13.6% directed to Healthier Together. Following this, we actively promoted the use of Healthier Together for safety netting advice. The subsequent parent satisfaction survey results showed that 91.3% of parents felt confident managing their child’s health post-discharge, reported receiving clear advice on recognising concerning symptoms and knew when to return to PED. However, 34.8% of respondents were non-English speakers, underscoring the need for multilingual resources, as only 87% felt they were directed to materials in their preferred language.What does it mean?This QIP highlights the importance of structured safety netting in paediatric emergency care. Although compliance has improved, gaps in resource distribution and accessibility remain. Parents provided positive feedback regarding the Healthier Together resource, highlighting its effectiveness. By implementing standardised protocols and focusing on tailored multilingual resources, we can enhance patient safety and better support families in managing their child’s health post-discharge. A second PDSA cycle is ongoing to evaluate the effectiveness of these interventions.ReferencesRCPCH. (2021). Facing the Future: Standards for Children in Emergency Care Settings. Royal College of Paediatrics and Child Health.NHS. (2020). Healthier Together: Guidance for Parents. NHS England.

Acute respiratory infections (ARIs) are a leading cause of under-five mortality globally. In Kenya, the reported prevalence of respiratory syncytial virus (RSV) infections in single-centre studies has varied widely. Our study sought to determine the prevalence of RSV infection in children admitted with ARI fulfilling the WHO criteria for bronchiolitis. This was a prospective cross-sectional prevalence study in five hospitals across central and highland Kenya from April to June 2015. Two hundred and thirty-four participants were enrolled. The overall RSV positive rate was 8.1%, which is lower than in previous Kenyan studies. RSV-positive cases were on average 5 months younger than RSV-negative cases.

ObjectivesIn late 2022, there was a widely reported increase in Group A Streptococcus (GAS) infections and child deaths in the UK, leading to increased unscheduled care presentations and demand for antibiotics. Interim UKHSA guidance advised clinicians to prescribe antibiotics to children with FeverPain score of three or greater.Our study evaluates the impact of introducing a Point of Care Test (POCT) for GAS using Abbott’s molecular ‘ID NOW™ Strep A 2’ on correct identification of children with GAS pharyngitis, antimicrobial stewardship and length of stay in a busy district general hospital paediatric emergency department.MethodsThroat swabs for laboratory culture and POCT were taken from children aged between 3 and 15 years with fever plus any of reported sore throat, tonsillar exudate, or severe tonsillar inflammation. FeverPain scores were deduced from recorded histories. POCT results were available within 6 minutes; if positive, we recommended antibiotic prescription. As per interim UKHSA guidance, those with FeverPain scores of 3 or greater, were advised to start empirical antibiotics, regardless of POCT results. We compared FeverPain scores with POCT results against the gold standard of laboratory culture results to examine the accuracy of identification of GAS pharyngitis and its impact on the length of stay.Analysis of patient, parental and staff satisfaction with POCT is still ongoing.ResultsIn our 16-day pilot, 46 POCT swabs were done; 10 positive on POCT, correlating with 8 GAS laboratory culture positive with one discarded mislabelled swab. All negative POCTs yielded negative throat cultures.Prior to test introduction, 15/32 (47%) children were discharged on antibiotics, of whom 9 had scores FeverPain of 3 or greater. Three children had swabs, and one child (FeverPain 2) grew GAS on culture and had to be recalled for antibiotics.Post-test introduction, 33/46 (70%) children were given antibiotics, of whom 11 had FeverPain scores of 3 or greater. Only 4/10 children with positive POCT had FeverPain scores of greater or equal to 3.Of 15 children with FeverPain scores more than or equal to 3, 14 were given antibiotics as per UKHSA guidance; only 4 were POCT positive.Interim data shows reduced ED stay (median of 25 minutes) since POCT introduction.ConclusionPOCT identifies children with GAS pharyngitis more accurately than the FeverPain scoring recommended on UKHSA guidance and, with further clinician education, could be used to improve antimicrobial stewardship. Length of stay has been reduced since the POCT introduction.Referenceshttps://www.england.nhs.uk/wp-content/uploads/2022/12/PRN00058-group-a-streptococcus-in-children-interim-clinical-guidance-december-2022.pdf (accessed 13.12.22)https://www.gov.uk/government/publications/group-a-streptococcal-infections-activity-during-the-2022-to-2023-season/group-a-streptococcal-infections-first-update-on-seasonal-activity-in-england-2022-to-2023( accessed 13.12.22)https://www.bbc.co.uk/news/health-63860028( accessed 13.12.22)Orda U, Mitra B, Orda S, et al. Point of Care Testing for group A streptococci in patients presenting with pharyngitis will improve antibiotic prescription. Emerg Med Australas 2016;28:199–204.

ObjectivesAccompanied refugee and asylum seeking children (ARASC) are children and young people under the age of 18 years who enter the United Kingdom to claim asylum with, and remain under the responsibility of, an adult. Unaccompanied asylum seeking children, (UASC) undergo a statutory initial health assessment (IHA) by a healthcare professional, but ARASC do not routinely receive a health assessment. This inequity of access to health surveillance may contribute to barriers to access to healthcare. We aimed to describe variation in current practices in health assessments for ARASC in England.MethodsWe undertook an online survey (using Qualitrics software) to explore the practice of health care professionals with regard to health assessments of ARASC in England. Participants were identified through professional networks using established mailing lists, through British Paediatric Allergy, Immunity and Infection Group (BPAIIG) and British Association of Paediatric TB (BAPT). Participants were not identifiable. We collected information on various aspects of health assessments for ARASC. Data were analysed using Excel.ResultsWe received thirty-five responses, some of which were incomplete. 50% (11/22) of respondents reported using a standardised approach to ARASC screening, and 91% (10/11) of these extrapolated existing UASC guidelines to this population. 43% (6/14) of respondents conducted infectious disease screening on all ARASC, even if asymptomatic. In terms of screening for TB infection, of those using Interferon Gamma Release Assay (IGRA), 60% (6/10) offered screening only in the context of risk factors, such as originating from a country with high prevalence. Blood-borne viruses screening (Hepatitis B, Hepatitis C, and Human Immunodeficiency Virus) was generally offered in all ARASC, rather than only in specific circumstances (60% (6/10), 55% (5/9), 55% (6/11) respectively).ConclusionThe proportion of all ARASC receiving any form of health assessment on arrival to England remains unknown and our findings show significant variation in the current practice of these health assessments. The Royal College of Paediatrics and Child Health (RCPCH) has up to date guidance (2022) on healthcare assessment for refugees and asylum seeking children and associated infectious diseases screening. However, our findings, although on a small sample, suggest that throughout England there is inconsistency in adherence to these national guidelines in the ARASC population. There is a need for further education and awareness around the needs of an initial approach to the ARASC population.

In mid-2015, there were an estimated 20.2 million refugees in the world; over half of them are children. Globally, this is the highest number of refugees moving across borders in 20 years. The rights of refugee children to access healthcare and be free from arbitrary detention are enshrined in law. Unaccompanied asylum-seeking children have a statutory medical assessment, but refugee children arriving with their families do not. Paediatricians assessing both unaccompanied and accompanied refugee children must be alert to the possibilities of nutritional deficiencies, infectious diseases, dental caries and mental health disorders and be aware of the national and international health guidance available for support.