ORIGINAL ARTICLE Implementation of a checklist to assist in the rapid identification of seriously ill children in the emergency department: An observational study Georgina Hayden, 1 Peter H Hewson, 2 David Eddey, 1 Darren Smith 1 and Peter J Vuillermin 1,2 1 Child Health Research Unit and 2 Department of Emergency Medicine, Barwon Health, Geelong, Victoria, Australia Aim: Interventions are required to expedite the identification and treatment of seriously ill children in the emergency department (ED). The aim of this study was to test the hypothesis that the implementation of a features of serious illness in children checklist (FSIC) for ED nursing staff would be associated with a reduction in the presentation-to-treatment time (PTTT) among children who required hospital admission and active treatment. Methods: An observational study was conducted 8 weeks before and 8 weeks after the implementation of the FSIC. The study was conducted in a busy combined adult and paediatric ED. Participants were children admitted to the hospital via the ED with a potentially life-threatening illness. Results: A total of 3640 patients age less than 18 years attended the ED during the observation period. Of these, 214 patients met the eligibility criteria: 111 pre-FSIC and 103 post-FSIC. The overall ED workload and case-mix were similar during the two observation periods. The PTTT was on average 16% (95% confidence interval, 17–33%; P = 0.302) longer following the implementation of the FSIC. Conclusion: The implementation of a checklist to assist ED nursing staff in the identification of seriously ill children was not effective in reducing the delay between presentation and the initiation of treatment among children who were admitted to the hospital. Larger studies are required to determine whether similar strategies are effective among a more critically ill subgroup. Consideration should also be given to alternative strategies to expedite the identification and treatment of seriously ill children in the ED. Key words: critical illness; emergency medicine; paediatric. A significant proportion of serious childhood illnesses in Austra- lia resulting in preventable morbidity and mortality are initially managed in an emergency department (ED). Early detection and treatment of these illnesses have an important impact on prog- nosis and outcome. 1–3 There is extensive literature describing the clinical features that may help to identify children with serious illness. 4–6 However, avoidable delays in the identification, inves- tigation and treatment of seriously ill children continue to occur. 7 Therefore, studies are required to investigate strategies that may help to translate scientific knowledge of the features of serious illness in children into clinical practice. This investigation was undertaken to assess the efficacy of implementing a features of serious illness in children checklist (FSIC) to be completed by ED nursing staff conducting the first post-triage assessment (i.e. the nursing assessment carried out when the child is brought from the waiting room to the clinical area, as apposed to the triage assessment, which is carried out when the patient first presents to the ED). The FSIC was developed by a multidisciplinary commit- tee comprising nursing staff, emergency physicians and paedia- tricians. It was designed to identify children with clinical features that have been previously shown to correlate with serious illness. 4–6 Nursing staff conducting the initial patient assessment were instructed to complete the FSIC and to notify a senior medical staff member if a child exhibited any of the features on the checklist. The aim of this study was to test the hypothesis that the implementation of the FSIC would be associated with a reduction in the PTTT among children presenting to the ED who subsequently required hospital admission and active treatment. Methods Setting The study was undertaken at Geelong Hospital, which is located 1 h south-west of Melbourne, Victoria, and services a Key Points 1 The implementation of features of significant illness checklist for emergency department nursing staff did not expedite the initiation treatment among children who were subsequently admitted to the hospital. 2 Checklists of this nature are unlikely to overcome systemic factors such as staffing levels, training and availability of space within the ED. 3 Larger studies are required to determine whether similar strat- egies are effective among a more critically ill subgroup. Correspondence: Dr Peter Vuillermin, Child Health Research Unit, Barwon Health, PO Box 281, Ryrie Street, Geelong, Vic. 3220, Australia. Fax: +61 3 5226 7953; email: peterv@barwonhealth.org.au None of the authors had any conflicts of interest relevant to this study. Accepted for publication 12 October 2008. doi:10.1111/j.1440-1754.2009.01489.x Journal of Paediatrics and Child Health 45 (2009) 274–278 © 2009 The Authors Journal compilation © 2009 Paediatrics and Child Health Division (Royal Australasian College of Physicians) 274