Aims We aimed to assess current triage and identification of sick children in our emergency department using the RCPCH standard of assessment within fifteen minutes of arrival, implement improvements as needed and re-audit to improve the quality of care and patient safety with our hospital.

Methods Audit was by retrospective case note review of children retrieved to PICU before and after implementation of improvement measures. We measured the time to first assessment by a clinician in the emergency department. Improvement measures included departmental presentation of these data, intensive teaching, monthly meetings reviewing the care of every child admitted to PICU, laminated signs listing danger signs and symptoms based on the Emergency Triage Assessment and Treatment (ETAT), helicopter rounds, updated guidelines and simulation training.

Results All children brought in by blue light ambulance were seen immediately (time to assessment=0 min) in the resuscitation area of the emergency department by paediatric medical and nursing teams. We therefore examined time to assessment for those not brought in by blue-light ambulance.

Conclusion Re-audit showed shorter time to initial assessment of sick children in the department following improvement measures. Numbers are too small to undertake any meaningful statistical analysis and we continue to collect data to identify areas for improvement. Time to assessment of children later retrieved to PICU by a nurse appears to have improved more than time to assessment by a doctor. The emergency department have not instituted a formal triage tool but use of the ETAT tool to classify children as either ‘emergency’ (who are then taken straight to the resuscitation area) or ‘priority’ (paediatric registrar to review within fifteen minutes) seems to identify 18/19 of the children in this cohort.