AimsFollowing the closure of a neighbouring emergency department our paediatric acute care services were expanded and re-structured to accommodate the predicted 20% increase in attendances. This study aimed to assess patient experience of the new acute care pathway.MethodsA double A4 page questionnaire was adapted from the validated RCPCH Patient Reported Experience Measure for urgent and emergency care. The survey was translated into Turkish and Polish to meet the needs of our population. It was distributed to patients and guardians attending A&E or the Paediatric Assessment Unit (PAU) for the month of December 2014.Results41 surveys were completed. Questions on patient understanding of information given and safety netting led to the most striking results. Less than half (44%) knew what was going on while waiting. Just over half (58%) stated they received clear information from doctors and nurses, although only 46% understood the diagnosis. Only a third (34%) of parents felt they knew what to look for following discharge.ConclusionSafety netting is an important concept that has gained greater attention over the last few years, particularly since publication of the NICE fever guideline. However, the best format of safety netting advice has been open to debate with growing evidence that providing written and audio-visual, in addition to verbal, discharge information increases knowledge and satisfaction. Based on the results of our study we have developed two new resources to improve safety netting in our paediatric emergency department. Firstly we produced two discharge booklets – one for minor illness and another for injuries – with information on common diagnoses, basic home management and safety netting using NICE traffic light criteria. These include a page for the clinician to fill in with details of discharge diagnosis. Secondly we have developed a series of short animated videos on viral illness, with voice-overs in a number of languages, to overcome difficulties due to language barrier and illiteracy in our multicultural population. If these videos are well received we will develop similar videos for other common illnesses.

BackgroundThe Laming Inquiry investigated the death of Victoria Climbie, a nine year old girl, at the hands of her great-aunt and partner. The Laming Report (2003) found a series of shortcomings within organisations involved and their ability to work together. 108 recommendations were made, 27 specifically directed to health. Our trust was one of the organisations highlighted in the report and we have audited the report’s recommendations since 2005.AimsTo review all audits since the Laming Report to ensure that safeguarding procedures are compliant with its recommendations.To examine whether audit recommendations were acted upon or whether the same common themes emerged at each audit cycle.MethodBetween 2007 and 2015, 6 audits of the Laming recommendations have been performed. Each audit examined 30 sets of notes in which safeguarding concerns were raised. The subsequent results and recommendations of each audit were examined for evidence of both good practice and areas where recommendations were not met.ResultsThe overall trend was an improvement in the number of recommendations that were fully met. The recommendation was regarded as fully met if it was documented in 100% of cases. Only 2 recommendations were fully met in 2007 and 7 in 2015. Where a recommendation was not met, there was a significant improvement between 2007 and 2015. Concerns were clearly documented in 58% of notes in 2007 and in 99% in 2015. Action plans were documented clearly in 67% of notes in 2007 and in 90% in 2015. Each year’s recommendations were acted upon with new documentation being introduced for example a discharge planning meeting proforma. One common theme raised was the need to improve of documentation of GPs, hospital number and school.ConclusionMeta-analysis of 8 years of audit of the Laming recommendations has shown some recommendations have become common practice with no child being discharged without discussion with a senior and documentation of consultant. Good documentation has a crucial role in all aspects of a patient’s care particularly in safeguarding and we still seek to improve documentation and communication within our trust and with other agencies.