Aims A group of children with complex medical problems regularly attend our A&E. Information about their background with a management plan can help their care to be prompt and effective. A paper folder of letters for these patients existed, but was out of date and rarely used, as it relied on parents or nurses to highlight the child’s arrival. The aim was to create an electronic folder of information on these patients linked to Cerner to improve patient management. It followed complaints about delays and lengthy history taking despite multiple attendances.

Methods All paediatric consultants at the hospital decided which patients would benefit. We created a proforma with diagnoses and initial management. This was a paper folder, and will become an electronic folder within the electronic records system. We created a "Child of Note" flag on Cerner, which shows on the patient triage board on the child’s arrival to A&E. We performed a retrospective cohort study, analysing attendances before and after the intervention. We assessed time from arrival in A&E to triage, and to doctor’s assessment, and surveyed key stakeholders to assess impact on their work.

Results 29 children were listed as a “Child of Note”. After the intervention, average time to triage improved from 18min to 16min, and average time to doctor’s assessment improved from 60min to 46min. We surveyed consultants, junior doctors and paediatric A&E nurses on their experience of the flag and folder. The responses were positive – 80% of those who saw it in use found it helpful, and comments included “it highlights that the patient is potentially quite ill, so … pick them up faster at triage”.

Conclusion Time taken to triage and clerking was reduced through the intervention. The flag allows children with complex medical problems to be identified on arrival, the folder allows optimal treatment to be started sooner, and becoming electronic enables easier maintenance. All trusts aim to replace paper notes with electronic, and simple changes like this can better utilise these systems.