National audit of emergency department child protection procedures.

OBJECTIVE To assess the compliance with national guidelines on child protection procedures and provision of paediatric services in major English emergency departments. BACKGROUND Victims of child abuse may present to emergency departments, and successful detection and management depends on adequate child protection procedures being in place. Two official documents published in 1999 provide recommendations for child protection procedures and staffing arrangements in emergency departments, and these can be used as standards for audit. METHODS Structured telephone questionnaire survey of English emergency departments receiving at least 18 000 child attenders per year. RESULTS Many of the standards are being met. Areas for improvement include: better access to child protection registers with clearer indications for their use; improved communication with other professionals such as the school nurse; more formal training for medical and nursing staff in the identification of potential indicators of child abuse; and improved awareness of local named professionals with expertise in child protection. More consultants with training in paediatric emergency medicine and more registered children's nurses are needed. CONCLUSION Many nationally agreed recommendations are being met, but there is a need for improved training, increased numbers of specialised staff, and improved communication between professionals. There is considerable variation in practice between departments.