Aims We conducted a quality improvement project looking at documentation in ED, assessing if basic assessment of risk was undertaken for all children seen and if safeguarding concerns were raised and referrals made appropriately. We then assessed if weekly feedback sessions given to the teams involved and a change in proforma improved the overall documentation of basic assessments of risk.

Methodology 97 notes were analysed over 7 weeks, selected at random from Paediatrics, Paediatric ED and Majors for 16–17 year olds looking at:

• Patient’s demographic details completed

• Documentation at triage if patient has a social worker

• Doctor documenting about social care involvement and full social history

• Concerns raised appropriately

• Referrals made appropriately

• Should concerns have been raised given the presentation? During the project we gave weekly 10 mins feedback sessions to ED and Paediatric teams highlighting our findings and explaining best practice guidelines. On week 7 only Paediatric notes, using a new clerking proforma with safeguarding questions pre-written, were analysed.

Methodology

Results The most significant findings were:

• 1617 year olds seen in Majors were triaged as adults triggering no questions on social care involvement.

• There was poor documentation by Doctors of social history and social care involvement across all 3 clinical areas for 86% of notes. This improved significantly after feedback sessions and the change in proforma.

• 4 cases raised safeguarding concerns, 3 of those were 16–17 year olds. Only 1 triggered correct referral procedures. We identified further 6 cases that should have triggered further safeguarding assessment. Of those 4 were of 16–17 year olds.

Results

Conclusion We have demonstrated that regular feedback and a change in proforma had a positive impact, improving documentation. However, the biggest concern remained about 16–17 years olds, who are a particularly vulnerable patient group. More work, including harmonisation of proformas for all children (under 18) seen in ED and further training needs to be undertaken to ensure full assessments are conducted on all children.