Aims An audit of new referrals made by a paediatric emergency medicine department to Children's Social Services and a survey of their outcomes and the feedback received, based on Lord Laming's 2009 recommendations.

Methods From March to July 2009, 9792 children attended paediatric accident and emergency (PA&E). Of them, 2.5% (245 cases) were discussed at a weekly multidisciplinary (MDT) meeting held within the PA&E. 21% (51 cases) generated a new referral to children's social service department (CSSD) and this included a review of emergency referrals. The majority of child protection referrals were to three inner-city CSSD's. All cases of concern were referred via fax to the CSSD where the family resided. The referral fax highlighted the reasons for referral and the cause of concern. A feedback form was faxed with the initial referral. In October 2009, each CSSD, which received a referral from PA&E between March 2009 and July 2009, were contacted using records from the MDT and asked:

• ▸ If an initial assessment had been completed.

• ▸ Whether the case referred was still open.

Results

Feedback Only one written form of feedback was received regarding a referral.

Conclusion The standard set by Lord Laming's 2009 report states all referrals to CSSD by other professionals should result in an initial assessment. The referring professional's should also be directly engaged with the assessment and receive feedback.1 During the 19-week period, 27.5% of referrals did not have an initial assessment and the department only received one written form of feedback from CSSD's.

Our recommendations are:

• ▸ Dialogue with the three main CSSD's, seeking education and a better understanding of referral thresholds and whether the information they receive from the initial referral is adequate.

• ▸ Adaptation of the referral system to include a graded system of concern.

• ▸ Development of a system to record all oral feedback given by CSSD's to PA&E.

• ▸ Feedback between PA&E and CSSD's via a password protected email system, with a monthly reminder set for all agencies involved to email feedback via pro-forma email.

• ▸ A re-audit in six/twelve month's time.