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N. Jones, K. Horridge.Sunderland Royal Hospital, Sunderland, Tyne and Wear, UK

Background and Aims: Attendance to Accident and Emergency (A&E) with an acutely unwell child with complex disabilities can be extremely stressful for parents, carers, nurses and doctors. Our experience is that parents can find it frustrating to meet staff in A&E who are unfamiliar with managing complex disabled children. Healthcare staff also describe feeling daunted by the challenge of assessing and managing children who may not show the usual cues to illness and may require specific or unusual treatments. We have developed a care pathway, designed to integrate with individual emergency care plans (where available), which we hope will improve the management of children with complex disabilities presenting to A&E.

Methods: Following discussion with nursing and junior medical staff working in our A&E department, a draft care pathway was developed. This was sent to all local hospital and community based medical and nursing staff involved in looking after children with disabilities for comment. The pathway was then modified to incorporate the suggestions made and redistributed for further review.

Results: The second version was agreed by consensus and is now in use on our A&E department. The pathway consists of an algorithm and a “checklist”. The algorithm focuses on the steps to follow if a disabled child brought to A&E is assessed as either having an acute serious illness or a minor illness/injury. For acute serious illness, the algorithm highlights the importance of using a child’s individual emergency care plan if available, involving consultant as soon as possible and thinking early about what level of input is appropriate. The “checklist” highlights key points to remember when assessing a disabled child—for example, occult sources of pain (teeth, ears, spine, hips). It also gives clear instruction about who should be informed …

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