6092 Safeguarding and holistic care for young people aged 16–17 who present to the paediatric emergency department at night

Objectives We set out to to compare the current practice of University College London Hospital (UCLH) Paediatric Emergency Department (PED) with the locally agreed standard, in line with GMC guideline1 that any patient aged 16 or 17 who presents to PED between midnight and 8am has a documented HEADSSS assessment and a consideration of a safeguarding referral or Redthread (PED based youth violence prevention programme) referral with consent, where applicable, and to test interventions to improve our adherence to the standard. Methods Anonymised data from electronic health records for 16–17 year olds who presented to UCLH PED at night between 1/07/2022 and 1/1/2023 was collected. Focus groups exploring doctors' and nurses' views on adolescents in PED were run in January 2023. Interventions addressing the need for better awareness and greater focus on adolescent health education, specifically an adolescents session as part of induction, departmental teaching on HEADSS and fortnightly safeguarding case review were put in place in January 2023. Data collection and focus group were repeated in April 2023. Results Pre-intervention: 111 Young People aged 16 or 17 presented to PED at night between 1/07/2022 and 31/12/2022. 52 were male, 59 were female, 43 were 16 years old and 68 were 17 years old 27 (24%) were intoxicated, 11 (10%) were brought in by the police, 17 (15%) presented with a traumatic injury, 16 (14%) included mental health issues in their presenting complaint 11 (10% had a HEADSS assessment, 30 (27%) had a documented safeguarding consideration and 3 (3%) were referred to Redthread In 34 (31%) there was no documentation of the parent or legal guardian being aware of the presentation Focus group revealed workload and limited awareness of the need to proactively screen for safeguarding concerns as barriers to adhering to the standard. Few participants were familiar with HEADSS. Post-intervention: Out of 11 patients who met inclusion criteria in April 2023, 4 (36%) had a HEADSS assessment and 6 (55%) had a documented safeguarding consideration. Focus group suggested that junior doctors were using HEADSSS to screen for safeguarding red flags. Conclusion Adolescents presenting to PED at night are a high risk group likely to have unmet safeguarding needs. The HEADSS tool is useful in screening,2 but is nderutilized due to lack of awareness and skill. Teaching sessions and incorporating adolescent medicine into induction improved adherence to local adolescent management standards at night. References General Medical Council. Protecting children and young people the responsibilities of all doctors. General Medical Council 2020. Contemporary Paediatrics, Goldenring JM, Rosen DS. Getting into adolescent heads: an essential update. Contemp Pediatr 2004;21:64–90.