6386 Audit on timing of child protection medical assessments in county Durham and Darlington NHS foundation trust (CDDFT)

Objectives It is vital that Child Protection (CP) Assessments are performed in a timely manner to protect children and gain evidence. We assessed Standards 2 and 8 of the Good practice service delivery standards for the management of children referred for CP medical assessments.1 2 Prior to this audit CDDFT aimed to see children for a physical abuse within 48 hours. At CDDFT we concerned that physical abuse referrals for children > 2 years on a Friday were being delayed and whether safety measures considered. The audit assessed whether child protection documentation completed correctly. Methods Retrospective audit of CP medical reports, covering 98 cases from September 2021 to February 2022. We collected data on date of referral, assessment, child's age and type of abuse. We differentiated between cases seen by safeguarding (SG) consultant or acute Paediatricians. We investigated the reasons for the delay for more than 48 hours and the day of the week when the child was referred. We evaluated whether there was documentation of safety measures agreed by social care when assessments delayed. We verified the presence of interim reports and the use of the correct age proforma. Results Graph shows Time child seen after referral 24% of cases had a delayed CP medical assessment (24/98) 92% of cases delayed were referred on Friday (22/24) No clear documentation about time of the referral on Friday 83% of cases had section 47 enquiry and safety measures in place (20/24) 12% of cases with > 48 hours delay (3/24) had medical review on the same day 85% of cases correct age porforma used (84/98) 48% of cases no evidence of interim report (48/98) 43% of cases were non accidental injuries (43/98) Conclusion Our safeguarding team need to address the recurring delays in CP medical assessments where physical abuse is suspected. We need to consider rescheduling Friday clinics, CP medicals performed by the acute team over the weekend or ensuring injuries are photographed and child in a place of safety whilst awaiting their medical. When CP assessments are unavoidably delayed, it is imperative to ensure clear documentation in medical notes, along with the formulation of a safety plan in collaboration with social care. A reminder about interim reports will be circulated. Furthermore, children's outpatient nurses should ensure age-appropriate proforma utilized. We have since changed local SG policy aiming to see children within 24 hours.3 We plan to repeat this audit in one year. References RCPCH Good practice service delivery standards for the management of children referred for child protection medical assessments, October 2020 Standard 2: Clinicians at the health provider organisation respond to requests for a child protection medical assessment in a timely fashion, following agreed documented local processes. Standard 8: The assessment, professional opinion and outcome from a child protection medical assessment is clearly recorded and communicated to the requesting professional as well as to the family and child as appropriate RCPCH Child Protection Portal, Chapter 6: The Medical Assessment and Admission to Hospital, 2013. CDDFT Child Protection Medical Assessments policy, January 2023.