(C Clin Pathol 1997;50:548-552)

TTTS treated with laser coagulation has reported eight (1.8%) cases of ABS. However, in this series, all the affected twins were recipient, seven out of eight donor twins died, and none of these had both feet affected (unlike our case). 2 Parents consenting for laser therapy in TTTS should be counselled for ABS. Competing interests None. Patient consent Obtained.Provenance and peer review Not commissioned; externally peer reviewed.Contributors SM diagnosed the case and was involved in researching the topic. SK and RR were involved in the management of the case. All three contributed to the writing of the article.

All those working with children should be able to assess safeguarding risks and potential harm (RCPCH, 2014).AimsWe conducted a quality improvement project looking at documentation in ED, assessing if basic assessment of risk was undertaken for all children seen and if safeguarding concerns were raised and referrals made appropriately. We then assessed if weekly feedback sessions given to the teams involved and a change in proforma improved the overall documentation of basic assessments of risk.Methodology97 notes were analysed over 7 weeks, selected at random from Paediatrics, Paediatric ED and Majors for 16–17 year olds looking at: Patient’s demographic details completedDocumentation at triage if patient has a social workerDoctor documenting about social care involvement and full social historyConcerns raised appropriatelyReferrals made appropriatelyShould concerns have been raised given the presentation? During the project we gave weekly 10 mins feedback sessions to ED and Paediatric teams highlighting our findings and explaining best practice guidelines. On week 7 only Paediatric notes, using a new clerking proforma with safeguarding questions pre-written, were analysed. ResultsThe most significant findings were:1617 year olds seen in Majors were triaged as adults triggering no questions on social care involvement.There was poor documentation by Doctors of social history and social care involvement across all 3 clinical areas for 86% of notes. This improved significantly after feedback sessions and the change in proforma.4 cases raised safeguarding concerns, 3 of those were 16–17 year olds. Only 1 triggered correct referral procedures. We identified further 6 cases that should have triggered further safeguarding assessment. Of those 4 were of 16–17 year olds. ConclusionWe have demonstrated that regular feedback and a change in proforma had a positive impact, improving documentation. However, the biggest concern remained about 16–17 years olds, who are a particularly vulnerable patient group. More work, including harmonisation of proformas for all children (under 18) seen in ED and further training needs to be undertaken to ensure full assessments are conducted on all children.