6330 Improving safety netting advice for parents and caregivers of children presenting to the emergency department with fever

Objectives When we send children who've had fever home from our Emergency Department (ED) we don't tell parents what to do next. If unsure – delays can lead to harm. If anxious they return unnecessarily. The Royal College of Emergency Medicine states children presenting to EDs with fever who are discharged home should be provided with an appropriate 'safety net' including information to take home.1 This quality improvement project aimed to improve the number of children who presented to our ED with fever who were discharged with appropriate safety netting. Methods An audit into the care of feverish children identified that there was inadequate safety netting being given to care givers of feverish children discharged from ED. A scoring system was created to measure the quality of discharge information given to care givers of feverish children. Notes of children under 5 who presented to ED with fever were retrospectively reviewed and assigned a score from 0 to 2 based on documentation (0= no safety netting documented, 1 = verbal information given, 2= specific verbal and written information given). 5 patients per week were sampled. Change ideas were tested using Plan-Do-Study-Act cycles including getting feedback from parents and stakeholders to create a poster with QR codes for patient information leaflets (PILs) accessible by caregivers within assessment cubicles. Results Baseline data showed a difference between patients 1–10 and 11–20 (median 1). The former being at odds with earlier audit findings. Poster introduction (PDSAs 3.1–3.3) coincided with less consecutive instances of caregivers having no documented advice (score = 0). The run chart (see chart) shows more instances of caregivers documented to have received verbal and specific written advice meeting statistical significance at the end of this project. This was accompanied by a significant reduction in the numbers receiving neither. Conclusion Previous audit data suggests the Hawthorne Effect2 may have elevated the median. Placing QR posters of PILs in assessment areas led to positive behaviour change increasing the recording of safety netting given to patients. This may have an impact on returners and caregiver confidence, although this data was not collected for this QIP. Further change is needed to ensure appropriate safety netting advice 100% of the time in line with Royal College Guidance. The posters included QR PILs for conditions other than fever in children. Further work could assess if there was improvement in the safety netting given to patients presenting with these conditions. References RCEM Feverish Child National Quality Improvement Project National Report 2018/19. RCEM. 2019 Chiesa M. Hobbs S. Making sense of social research: how useful is the Hawthorne Effect?. Eur. J. Soc. Psychol., 2008;38:67–74.