Aim Since 2014, 6 paediatric nurses, 2 PEM consultants and 3 registrars have been introduced into the paediatric emergency department. This study aimed to assess whether having additional paediatric staff made a difference to the quality of patient care delivered.

Method An audit in 2014 assessed quality of care against the RCPCH and CEM documents, ‘Standards for children in emergency care settings’ and ‘Clinical quality care indicators’. Although current medical rotas remain short of a full complement, there is increased presence of PEM trained staff on the shop floor. The 2014 audit was repeated with additional focus on gaps in service and the implementation of dedicated PEM staff in 2016.

Results 1338 patient notes were reviewed. 781 in 2014 and 557 in 2016. Key findings included:

– Time with PEM staff present on the shop floor was 19% in 2014 and 56% in 2016.

The triage target time of <15 mins was achieved in 78% in 2016 compared with 53% in 2014.

–41% of patients were seen by clinicians in accordance with their designated triage categories in 2014. This improved to 67% in 2016.

– Without PEM staff cover in 2016, only 48% of patients were seen in keeping with their triage category. When PEM staff were present, this increased to 94% of patents.

– Overall admission rate in 2014 was 28% compared with 7% in 2016. It was felt that 60% of admissions in the absence of PEM staff were potentially avoidable.

Conclusion This audit shows having paediatric trained nursing and medical staff has a positive effect on the quality of patient care. We are hoping to continue to build our team to enable us to cover a larger proportion of out of hours, using the evidence gathered during this study.