Aims RCPCH has recommended a move towards ‘consultant-delivered service’, stating that consultants “make better decisions more quickly” and that “availability of consultants can decrease the rate of unnecessary admissions”. In our unit a twilight consultant shift is in place 3 days per week from 12:30 to 21:30.

Methods A retrospective case note review was undertaken on 93 attendances to Children’s Assessment Unit (CAU) over a 6 month period.

We used the RCPCH ‘Facing the Future: Standards for Paediatric Services’ which recommends a senior review within 4 h and consultant review within 24 h of admission. We also looked at decision making regarding admission including a comparison between consultants and middlegrade doctors.

Results The main source of referrals to CAU is GPs. Overall, 63% of attendances lead to admission. Admissions are short with 46% of patients admitted staying for only 1 day. Admission rates are similar between Consultants (67%) and Middlegrades (71%). 82% of patients attending CAU have a decision regarding admission within 4 h.

76% of children attending CAU are reviewed by a senior, 54% are within 4 hrs. 59% see a consultant within 24 hrs.

Peak hours of attendances are 16:00 to 20:00. During twilight shifts consultants undertake 53% of senior reviews, compared to 9% at other times.

Conclusions Decisions regarding admission are mostly made in a timely manner. Rates of senior review could be improved. We suggest changing expectations in medical and nursing staff and improving documentation of cases discussed with seniors. Consultants may use the morning ward round as an opportunity to review new patients within 24 h of admission. Understanding peak hours of activity helps us plan rotas. We plan to reaudit this soon.