Background and objectives Feverish illness in children is a common reason for hospitalisation. Guidance has been issued by NICE as fever can be a diagnostic challenge. The aim of this audit was to determine if the NICE guideline was being adhered to within the Emergency Department and, if not, where improvement was needed.

Methods This was a retrospective audit reviewing the charts for all children under five years of age attending the Emergency Department within a one month period. These charts were selected using the audit function of the ‘Symphony’ system. A total of 50 charts were included in the audit. Pyrexia was defined as temperature greater than 37.8

Results 70% were assessed out of hours.

62% had a fever for <72 h.

62% failed to complete a traffic light category for the child.

Only 30% mentioned hydration status.

Only 6% assessed for lymphadenopathy.

Only 6% documented joint examination.

Of those children only reviewed by junior medical staff 44% sought advice from senior colleagues.

66% of children were admitt.ed to the hospital.

70% of those discharged from the Emergency department were given a safety net in terms of when to return to hospital.

98% of children discharged from the Emergency department did not return within the following week.

Conclusion Increased awareness of the NICE guidelines will help improve documentation and ensure that disease specific clinical signs are considered and diagnostic uncertainty is minimised. All cases should be discussed with senior colleagues.