Increasing presentations to urgent and emergency care settings throughout the world have created a huge challenge for health services. Although ensuring that serious illness and injury is identified, and promptly treated, the large majority of children presenting have relatively minor problems. Developing systems, and education, to ensure that the right children are identified for further treatment and those that do not need hospitalisation are safely discharged will be vital as resources become increasingly limited. Within hospital identifying the child who requires an escalation of care is also important as there is a frequent pattern of ‘failure to recognise deterioration’ throughout the world.

Various scoring systems – whether triage, early warning, illness identification or illness severity have been developed in children. The component of ‘gut feeling’ or gestalt is relatively unexplored however. This presentation will review current research on gut feeling and using the results of the implementation of the Paediatric Observation Priority Score, a bespoke scoring system for use in children’s urgent and emergency care, to explore how nurse’s gut feeling is an important factor in managing the acutely unwell or injured child in health care settings.