Background The NHS is facing unprecedented pressure to provide care with an ever decreasing budget. Inspired by the Choosing wisely initiative and a recent document by the Academy of Medical Royal Colleges, which have documented positive changes in improving patient care by highlighting areas of overdiagnosis and overtreatment.

Methods A workgroup of junior and middle grade doctors and an operational manager identified common presentations to the paediatric ED. Seven presentations were chosen and the most common diagnostic tests ordered listed, which were compared to national guidelines. The cost of all of the tests were sought and the difference calculated.

Results The chosen presentations to the paediatric ED with proposed changes are: pneumonia, bronchiolitis, gastroenteritis, cellulitis, asthma, febrile convulsions and ankle/knee injuries. Spot check initial results showed significant potential cost savings without compromising best patient centred care. There would also have been a significant reduction in potential pain and discomfort to the patient and a reduction in unnecessary radiation exposure.

Conclusions Better patient care can be achieved by following national guidelines more strictly, with the added benefits of less waste and cost savings. We have calculated as a conservative estimate, that if our department reduced only 30% of the identified unnecessary tests, a saving of £20,000 per annum could be achieved.