Aim To design, implement and audit an APAU with a defined patient pathway for all acute referrals. Primary outcomes would include admission rates, time to assessment, time to decision and questionnaires.

Method Retrospective data was collected to provide a baseline against which to judge efficacy of intervention. A designated area was identified and equipped as an APAU. Patient pathways were agreed along with a new admission proforma. A 4-week pilot was carried out from 8 am–8 pm Monday to Friday. Data collected included time of arrival and assessment, admission rates, parental and staff satisfaction.

Results During Jan 2013 and April 2013 between 8 am–8 pm there was a total of 785 admissions. A retrospective analysis was carried out on 80 randomly selected charts. Ages ranged from 3 weeks to 13 years 9 months, with a median age of 3 years 5 months. 97% of patients were seen within 4 h of nursing triage with only 59% being reviewed by a senior doctor within the following 4 h of their initial medical review.

There were 100 APAU admissions during May 2013. Only 87 charts were available and audited. Ages ranged from 2 days to 14 years with a median age of 1 year 7 months. Common diagnoses included gastroenteritis and respiratory tract infections. 100% of patients were medically assessed within 4 h of nursing triage with 85% of patients being reviewed by a senior doctor within the following 4 h (p value 0.01).

Admission rates fell from 95% to 44% during the hours of 8 am–8 pm (p value < 0.0001). Staff impression of our facilities for managing direct admissions as good or excellent improved from 25% to 95%. Patient and parent feedback was excellent.

Conclusion We have shown that developing a model of acute paediatric assessment in a DGH setting can both reduce admissions and improve quality outcomes. Both physical infrastructure and funding remain issues for sustainability however we believe that this project demonstrates the value in investing in acute paediatric care.