My unit is trying to improve the service for our children with direct access, that is, children who may self-refer to the PAU due to the child's underlying condition.

Some of these children, particularly those with conditions such as CAH or those requiring 'rescue' medication, parents will present and inform the first staff member of their child's needs. However, we are having issues with some parents either not highlighting to reception or streaming/triage nurses that their child has direct access, or long waiting times for triage or to be seen by a doctor-- often because the child may be triaged as 'low priority' when the context of their condition is missed.

As our Unit is a combined PAU and Children's A&E within a DGH A&E, we are looking at implementing a 'red card*' scheme wherein parents can highlight the child's status as a direct access patient to the reception and the child will be booked-in and assessed immediately in the Children's Department by the nurse in charge. 

Further to this, and obviously ensuring the direct access 'folder' and plans within are current, has anyone got any advice for ways to streamline the process? 

*Red card- i.e. a card with the child's information, including personal data, their diagnosis, current medications and emergency treatment plan.

I have been thinking that it may be a good idea to include something along the lines of symptoms to look out for (not simple 'triage' assessment but those which are subtle and specific to the more rare conditions) or tests which need to be carried out immediately in the event of their presentation?

Also possibly with those children under shared care with specialist centres, the contact details and consultant that may need to be contacted, should advice need to be sought by the local paediatrician. This way the parents need not bring a wad of papers every time.

Really, any contributions to make the process more efficient, or any experience that has helped improve the service would be great.

Thank you!