Implementation of a clinical decision-making pathway for feverish illness in children younger than five years

Background Fever in children is a common reason for seeking advice from healthcare professionals. The challenge is to determine which children have a simple self-limiting cause and which have a potentially serious or even life-threatening illness that needs urgent treatment. In 2007 the National Institute for Health and Clinical Excellence (NICE) for England and Wales produced a guide to the assessment and initial management of feverish illness in children younger than five years. This aims to help guide parents and healthcare professionals to identify those at risk of serious illness. Methods We implemented this NICE guidance by producing a clinical decision-making pathway to be used by staff to assess children who present to the Emergency Department at Royal Liverpool Children’s Hospital with fever, where the source is not immediately apparent. This pathway follows a “traffic light” system to categorise patients into high, medium and low risk of serious illness, and direct appropriate investigation and treatment strategies. Discussion The intention is that the pathway will improve patient care by standardising clinical assessment, investigation and treatment of these children. In addition, it ensures that clinicians are aware of updated national guidance, aids teaching and education of junior medical and nursing staff and provides a convenient way to audit clinical practice. The pathway we have designed will be of interest to others involved in the emergency care of children. Our poster will present this pathway, display the results of an ongoing audit of its use and discuss the challenges of implementing national guidance.