Background: Hospital admissions for febrile children contribute significantly to bed pressures, yet many are self-limiting viral illnesses. NICE NG143 emphasises the importance of safety-netting, but local pathways vary between countries.As per the Royal College of Paediatrics and Child Health (RCPCH), ten standards have been set out to ensure safe and acute general paediatric services of high quality. With regards to discharge, one of the standards is to ensure every paediatric patient with an acute medical problem has their case discussed with or is seen by a competent clinician who has the necessary skills, and this is to ensure a safe and appropriate discharge.A European study was conducted and found across Europe that the use of Paediatric Early Warning Systems (PEWS) scoring and Rapid Response Teams varies, but these are important for quality care and early recognition of a deteriorating paediatric patient. Furthermore, initiatives such as Open Access (OA), Virtual Ward (VW), Hospital-at-home (H@H) and clear safety netting (SN) measures may safely reduce admissions.For example, a study into virtual wards was conducted and found that their implementation offers satisfaction for both patients and staff. A staff model from this study found if a paediatric patient meets the criteria for admission, with the help of VW, a child can be directed to either an on-call General Practitioner, an on-call Physician, or a disease-specific unit - this aids prioritisation, sustainability, and patient safety (3). We aimed to review outcomes for febrile children managed through admission versus alternative pathways in our trust.Methods: A retrospective audit of all febrile children seen in PAU over 2 months was conducted. Data included demographics, NICE stratification, investigations, antibiotics, outcome (admission, discharge, OA, VW, H@H), and readmission. Outcomes were compared between children admitted versus those managed through alternative pathways.Results: Of 144 children, 15.28% were admitted, 18.05% discharged home, 63.19% discharged with OA, and 3.47% referred to VW/H@H.- Admission rates were higher in children with >5 days of fever or amber/red stratification.- Of those discharged with OA/VW/SN, only 1.04% required readmission.- Antibiotic use was 90.9% in admitted vs 53.13% in OA/VW group.Alternative pathways safely reduced admissions without significant readmission rates.Conclusion: Our audit highlights the value of OA, VW, and SN in reducing unnecessary admissions for febrile children. Most patients were safely discharged with OA, showing that this system is useful. Meanwhile, antibiotic use was not only high in the group of admitted children, but it was also reasonably high in children discharged with OA or VW, which shows OA/VW/SN models help ensure safe clinical care and follow-up.With appropriate stratification and safety-netting, these models can preserve hospital capacity while maintaining safety. Wider implementation and prospective evaluation could further support NHS recovery plans.
