Audit Period Research Articles

HPB SO60 - A Re-Audit: Radiological Investigations In Patients Diagnosed With Gallstone Disease

Abstract Background Gallstones disease is very commonly encountered in general surgery and often detected by different modes of imaging. NICE guidance advises offering liver function tests and ultrasound where gallstones are suspected. MRCP and EUS are then considered if gallstones have not been detected. However, ultrasound is not always offered first line in patient cases, for varying reasons. This retrospective audit aims to assess the different radiological investigations used in gallstones against NICE guidance and the reasons behind this. Method Data was collected from a cohort of 108 patients over a 2 month period, all diagnosed with gallstones. The data collected included information regarding their demographics and imaging used to diagnose gallstones, as well as the reasoning when the first line investigation was not used. These results were then presented at the local general surgery CGM, findings were also communicated to doctors within the hospital. The audit was then repeated a year later with a similar cohort of patients, to compare findings. Results Mean age of patients decreased from initial audit to reaudit periodFemale preponderance in both audit and re-audit cyclePatients more likely to have imaging when abdominal pain present AND deranged LFTs as opposed to just one of the twoComparing total number of scans: less patients are undergoing CT scans (44 in audit period vs 31 in re-audit period)- 30% decreaseDecrease in number of patients having CTAP as first mode of scan (38 in audit period vs 21 in re-audit period). Total of 45 % drop. Conclusion While ultrasound scan is the first line radiological investigation where gallstones are suspected, it is not always the first to be used. This is for a plethora of reasons, including:Differing clinical judgment/ diagnostic uncertaintyDifferent clinicians/ specialities booking investigationsUnawareness of NICE guidanceLogistical delay in ultrasounds However, it does appear there has been improvement in adherence to NICE guidance between first and second cycle. Other modes of awareness will be implemented to further improve this, including publishing further guidance about NICE protocol within the trust so this is more easily accessible to doctors.

HPB SO39 - Incidence for the need of blood transfusion for Laparoscopic Cholecystectomy :Is a group and save always needed ?

Abstract Background Major bleeding is rare but among the most serious complications of laparoscopic surgery. As low as 1.3% of patient undergoing laparoscopic cholecystectomy may require a blood transfusion. We propose that not all patients undergoing laparoscopic cholecystectomy require a valid group and save sample, as the risk of bleeding is minimal. Method Health records of 458 patients who underwent cholecystectomy at our two hospital sites were reviewed for blood transfusion up to 30 days post-operatively. This review included elective and emergency procedures from January 2023 till March 2024. Demographics and surgical outcomes, including preoperative Haemoglobin (Hb) levels, need for transfusion, reason for transfusion and amount of units transfused were recorded. We analysed nominal values in proportions and percentages. Results Average pre-operative Hb levels were 13.38 g/dl. 7 patients required peri-operative blood transfusion. Three patients requiring transfusion had conversion to open cholecystectomy. Three patients requiring transfusion underwent emergency procedures. Time to transfusion ranged from 2 hours-5 days. All patients requiring transfusion were at our main hospital site (Watford General Hospital). Our yearly cost of ordering routine group and save sample throughout the audit period was £12,824 Conclusion Routine group and save is not required prior to Laparoscopic Cholecystectomy. In case transfusion is required sufficient time to process a group and save samples is present. High risk patients i.e those with known haematological malignancies, coagulopathy, concurrent use of blood thinner, higher ASA grades can be identified and selective blood grouping performed.

Do government environmental audits reduce air pollution? Evidence obtained from Lanzhou

IntroductionThis study investigates the effectiveness of government environmental audits in mitigating air pollution. Specifically, it focuses on a pilot project conducted in Lanzhou City by the former Ministry of Environmental Protection. The research employs a regression discontinuity design to empirically assess the impact of these audits on air quality.MethodsThe study utilizes a regression discontinuity design to evaluate the impact of the government environmental audits. The primary outcome variable is the Air Quality Index (AQI). The analysis includes extensive robustness checks, such as sensitivity testing for optimal bandwidths of key pollutants, adjusting for precipitation levels, and conducting various robustness tests to ensure the reliability of the results.ResultsThe findings reveal a significant decline in the AQI following the implementation of the environmental audits. The AQI decreased from 31 to 25 during and after the audit period. Additionally, the study observed a notable increase in precipitation levels, suggesting potential environmental improvements. Robustness tests further confirm the reliability of the regression results.DiscussionThe research outcomes demonstrate the effectiveness of government environmental audits in reducing air pollution. By supervising local governments in the implementation of environmental protection policies, these audits contribute to improved air quality. The findings highlight the importance of targeted interventions and policy enforcement in addressing environmental challenges.

Noise in a UK intensive care unit: a retrospective cohort study

Excessive noise in hospital Intensive care units (ICU) has been associated with adverse health effects and human factor impacts acknowledged to negatively affect both patients and healthcare providers. Aims: Evaluation of the acoustic environment of the Royal Liverpool University Hospital (RLUH) ICU versus WHO and UK guidelines. Methods: Noise measurements were taken from a six-bedded bay within the RLUH ICU between 15th June and 1st July 2022. This audit focussed on noise data > 87dBA, in accordance with the national exposure limit established by UK Noise Regulations. A retrospective review of relevant patients' records was conducted to identify potential noisy events during the audit period. Results: The highest and lowest LAeq value was 77.9 and 63.5dBA, respectively. All LAeq and LAmax noise measurements recorded exceeded recommended guidelines. Noise fell below recommended daytime guidelines less than 1% of the time. The top potential causes of noise were patient repositioning/personal care, medication administration and suctioning. Conclusion: Noise levels in the RLUH ICU considerably exceed national and international guidelines. These findings highlight the need to address noise pollution in the ICU setting. Hospital staff and policy makers should consider implementing strategies and interventions for noise reduction in ICUs.

Auditor mood and audit quality: evidence from music sentiment measure

PurposeExtant studies propose music sentiment as a novel measure of individuals’ sentiment. These studies argue that individuals’ choice of music reflects their emotional condition in real time and influences their cognitive ability, making it a powerful tool for assessing their mood. This study aims to use music sentiment as a proxy for auditors’ mood and explore its impact on audit quality.Design/methodology/approachA sample of the US firms from 2017 to 2020 is used in the study. The authors apply the ordinary least squares regressions and the logit regressions to the audit quality models. The authors use absolute discretionary accruals and the propensity to meet or beat earnings forecasts as proxies for audit quality and calculate a stream-weighted average sentiment measure for Spotify’s Top-200 songs of each day during the audit period of a client firm to capture the sentiment of auditors.FindingsThe authors find that music sentiment is positively associated with audit quality. The result is consistent with the mood maintenance hypothesis, which suggests that a positive mood can induce auditors to be more careful in risky situations. Furthermore, the result is robust to various sensitivity analyses.Originality/valueThe study contributes to the scarce literature that focuses on auditors’ emotional state and highlights the importance of monitoring auditor mindset during the audit period.

Medication management and electrocardiogram screening in children with attention deficit hyperactivity disorder.

To quantify the proportion of referrals sent to Crumlin Cardiology Department for cardiac screening prior to commencement or modifying attention deficit hyperactivity disorder medication and assess the number detected with a clinically significant abnormality. A prospective audit was performed over a 6-month period, from November 2021 to April 2022 inclusive. Referrals sent via outpatient department triage letters, electrocardiogram dept. email, and walk-in electrocardiogram service were screened for those pertaining to commencing or modifying medication for children with attention deficit hyperactivity disorder. Each referral was coded against National Institute for Health and Care Excellence guidelines to determine the degree of clinical details given. Reported abnormalities, recommended management, and correspondence were recorded. Ninety-one referrals were received during the 6-month audit period. More than half lacked a clinical indication for referral (53/91, 58.2%), with fewer than one third (26/91, 28.5%) meeting National Institute for Health and Care Excellence criteria for referral for cardiology. Eighty (80/91) referrals had clinical outcomes available for review (missing outpatient department information and age outside of service range accounted for eleven referrals with unavailable clinical outcomes). Of the eighty clinically reviewed referrals, seventy-two (72/80, 90%) were reported as normal with no cardiology follow up required. Eight referrals (8/80, 10%) were reviewed in the Cardiology Outpatient Department prior to commencement or modifying attention deficit hyperactivity disorder medication. Of these, only one (1/80 1%) had a clinically significant abnormality which was a potential contraindication to attention deficit hyperactivity disorder medication use, and this referral was appropriate as per National Institute for Health and Care Excellence guidelines. Routine screening prior to attention deficit hyperactivity disorder medication prescription in the absence of clinical indications (as per National Institute for Health and Care Excellence) contributed to delays in medication initiation among young people with attention deficit hyperactivity disorder. Unnecessary referrals have resource implications for cardiology clinical team. Improved adherence to National Institute for Health and Care Excellence guidelines would provide benefits for patients and clinicians.

EP335 - Audit of the Use of WHO Surgical Safety Checklist and its Awareness, Perception and Acceptability Amongst Theatre Personnel in a Tertiary Hospital in Sub-Saharan Africa

Abstract Aims The World Health Organization Surgical Safety Checklist (SSC) was developed to prevent perioperative adverse events. This study aimed to assess the utilization of the SSC and evaluate awareness and acceptability among theatre staff at a tertiary centre in sub-Saharan Africa. Methods We conducted a prospective audit of the SSC utilization during elective and emergency surgery, and a survey of awareness, perception and acceptability amongst theatre personnel (nurses, surgeons and anaesthetists) using a 15-item self-administered questionnaire between May 2022 and January 2023. Results 117 surgeries were observed for compliance with SSC and 81 theatre personnel took part in the survey. The checklist was used in 52.1% of all surgeries, 80% and 5.4% of major and minor surgeries respectively. In Time Out phase, activities were stopped in 23% of cases, and scrub nurses were asked relevant questions 31-47% of the time. Sign Out was the least completed phase. Three of five questions were asked 23-48% of the time. 28% of respondents who previously witnessed adverse events agreed that they could have been prevented by proper implementation of the SSC. 65.4% of members of the surgical team had not had any formal training on the SSC. There was no difference in its awareness, perception and acceptability based on profession of the respondents. Conclusion SSC was not fully utilized during the audit period. Lack of formal training may be contributory. There is broad awareness of SSC and its ability to prevent advert events. Key words: WHO, Surgical Safety Checklist, Awareness

Do major public emergencies affect audit quality? —Evidence from China

ABSTRACT Taking Chinese listed firms from 2019 to 2021 as research samples, we examine the impact of major public emergencies on audit quality using COVID-19 as exogenous shock. Distinguishing the location of audit clients and that of auditors, we find that if major public emergency occurs in the city of audit clients during the period of annual report audit, audit quality will be significantly reduced. If emergency occurs in auditor’s city, audit quality has improved instead of declining. Through the heterogeneity test, we find that the information level of audit clients has a double effect. When public emergencies in audit clients’ locality have a negative impact on audit quality, the information level of clients can alleviate the negative impact. However, when emergencies occur in auditor’s locality, the higher information level of the client may lower audit quality. However, whether public emergence occurs in the city of clients or auditors, auditing firms’ information technology level and more information technology personnel in auditors’ team are conducive to improve audit quality. The research has enriched the relevant research on audit quality in the context of public emergencies, and provided a theoretical basis for the urgency of digital transformation of accounting and auditing industry.

Audit Tenure Sebagai Moderasi Fee Audit dan Ukuran Perusahaan Terhadap Kualitas Audit

Apart from being required to comply with the code of ethics, auditors must also understand client requests. In their involvement with the company, auditors will relate to the audit fees received, the audit period which has an impact on the quality of the resulting audit. This study aims to investigate the impact of audit fees, audit tenure, and audit rotation on audit quality in companies listed on the Indonesia Stock Exchange LQ45 Index from 2020 to 2022. The study employs quantitative data from secondary sources, utilizing documentation as the primary data collection technique. Data analysis is conducted through logistic regression test techniques, with totaling 69 samples. The results show that audit fees have a negative effect on audit quality, while company size has no effect on audit quality. Audit tenure can moderate the effect of audit fees on audit quality, but cannot moderate the effect of company size on audit quality. The discussion further explores the implications of these findings on auditing practices, potential areas for improvement, and considerations for regulatory frameworks.

PENGARUH KESULITAN KEUANGAN, KEGAGALAN HUTANG DAN MASA AUDIT TERHADAP OPINI AUDIT GOING CONCERN ( Studi Empiris Pada Perusahaan Yang Terdaftar Di Bursa Efek Indonesia Tahun 2021-2022 )

This research aims to find out and test how financial difficulties, debt failure and audit period influence going concern audit opinions on companies listed on the Indonesia Stock Exchange in 2021-2022. The population in this study amounted to 778 companies. The number of samples in this study was 53 samples. This research method uses quantitative methods. The data analysis method used in this research is logistic regression analysis as a data processing test tool. The results of the research analysis show that financial difficulties have an effect on going concern audit opinion, while debt failure and audit period have no effect on going concern audit opinion

670 Investigating Delay During Presentation of Trauma in Young Adults: A UK Major Trauma Centre Retrospective Audit and a Systematic Review of the Literature

Abstract Introduction The current evidence in major trauma highlights that delays at multiple points along the patient care pathway, from incident to surgery, are associated with decreased survival. The aim of this audit was to assess performance across select delay parameters in juveniles aged 16-18 presenting to an adult MTC service following a systematic review of the literature. Method Patient records were interrogated between 1/10/2022-1/3/2023 and audited against 3 national standards: (1) Ambulance Response and Transfer (7 and 45mins respectively) (2) Tranexamic Acid infusion (<3hrs) and (3) CT scan (<60mins). A systematic search was also performed using EMBASE and OVID databases (01/01/2005-/01/11/2023). All studies assessing impact of time to theatre in patients with acute trauma were considered. Results 32 consecutive patients (3F:29M) (median 18 years[16-18]) were identified within the audit period. 40%(n=13) presented following penetrating injury and 35%(n=11) following a road traffic accident. Mean time from incident to admission was 83mins[±36], from incident to tranexamic acid infusion 50mins[±35], and from admission to CT Trauma Series 61mins[+/-100]. Median length of stay was 4 days [IQR=5]. The systematic search yielded 25 studies which were included in the analysis. An Incident2Surgery framework is presented which highlights key time-critical points for diagnosis and intervention. Conclusions Local compliance to national standards for tranexamic acid infusion in appropriate patients and performance of trauma CT was excellent with poor compliance to ambulance arrival and transfer time. The proposed Incident2Surgery framework could be incorporated into mortality prediction and audit tools and assist in the assessment of interventions.

The Impact of COVID-19 on the Quality of Auditing from the Point of View of Jordanian Certified Public Accountants

The aim of this study is to investigate the impact of the COVID-19 pandemic on audit quality from the perspective of Jordanian Certified Public Accountants. It also aims to identify any differences in the views of Jordanian Certified Public Accountants regarding this impact based on respondents' demographic characteristics such as gender, academic qualification, scientific specialization, job title, years of experience in audit, and professional certifications. A quantitative approach was used in this study, where 150 questionnaires were distributed to 150 Jordanian certified public accountants, and 144 questionnaires were retrieved (27 of them were incomplete), resulting in 117 questionnaires being used for statistical analysis. The results of the study indicated that the COVID-19 pandemic had a significant impact on audit quality through the dimensions of audit fees, going concern assessment, audit procedures, auditor's experience, audit period, and audit firm size. The results also showed that there were differences in the views of Jordanian Certified Public Accountants regarding the impact of the COVID-19 pandemic on audit quality based on academic qualification, job title, and years of experience in auditing, while no differences were attributed to gender, scientific specialization, and professional certifications of the respondents. Based on the study's findings, the researcher provides several recommendations, including: Audit firms should prioritize the development of skills and experiences of their employees through alternative training programs and remote work arrangements. Audit firms should also review their audit processes and procedures to adapt to the new business environment created by the COVID-19 pandemic. Regulatory bodies should consider reviewing their oversight standards to address the exceptional challenges posed by the COVID-19 pandemic especially with regard to auditing and quality auditing.

Improving access to patient information leaflets in patients undergoing emergency appendicectomy

Background
 Informed consent is a cornerstone of ethical surgical practise. Patients undergoing emergency surgery have reduced time to consider their options when compared to the elective setting. Therefore, improving informed consent in this setting is critical. We aim to increase the provision of a pre-operative patient information leaflet (PIL) for patients undergoing an emergency appendicectomy by 50% over two audit cycles.
 Methods
 The same methodology were used for both cycles of this audit. Patients were identified through histopathology lists over a two week period. Medical notes were reviewed for documentation of provision of trust approved patient information leaflets. A QR code for an electronic version of the information leaflet was added to emergency clinic rooms, doctors handover rooms and the SHO on call bleep between audit periods.
 Results
 Empirical results from two audit cycles revealed that introduction of a QR code increased uptake from 0% of patients receiving the recommended appendicectomy leaflet, to 58%, achieving our aim.
 Conclusion
 The QR code provided a useful transportable resource, which was utilised by doctors. This provides scope for progression in provision of leaflet for other surgical issues, both in inpatient and outpatient settings, through utilisation of a QR code.

Pediatric invasive device utility and harm: a multi-site point prevalence survey

Background and aimsInvasive devices are widely used in healthcare settings; however, pediatric patients are especially vulnerable to invasive device-associated harm. This study aimed to explore invasive device utility, prevalence, harm, and clinical practice across three Australian pediatric tertiary hospitals.MethodsIn 2022–2023, a multi-center, observational, rolling-point-prevalence survey was conducted. Fifty-per-cent of inpatients were systemically sampled by random allocation. Patients with devices were then followed for up to 3-days for device-related complications/failures and management/removal characteristics.ResultsOf the 285 patients audited, 78.2% had an invasive device (n = 412 devices), with a median of 1 device-per-patient (interquartile range 1–2), with a maximum of 13 devices-per-patient. Over half of devices were vascular access devices (n = 223; 54.1%), followed by gastrointestinal devices (n = 112; 27.2%). The point-prevalence of all device complications on Day 0 was 10.7% (44/412 devices) and period-prevalence throughout the audit period was 27.7% (114/412 devices). The period-prevalence of device failure was 13.4% (55/412 devices).ConclusionsThe study highlighted a high prevalence of invasive devices among hospitalized patients. One-in-ten devices failed during the audit period. These findings underscore the need for vigilant monitoring and improved strategies to minimize complications and enhance the safety of invasive devices in pediatric hospital settings.ImpactA high prevalence of invasive devices among hospitalized patients was reported. Of the 285 patients audited, almost 80% had an invasive device (total 412 devices), with a median of 1 device-per-patient and a maximum of 13 devices-per-patient.The most common devices used in pediatric healthcare are vascular access devices (n = 223; 54.1%), however, 16% (n = 36) of these devices failed, and one-third had complications.The point prevalence of all device complications at day 0 was 10.7% (44 out of 412 devices), with a period prevalence of 27.7% (114 out of 412 devices) throughout the audit period.

Biomass analysis of resource utilization system

This paper uses the biomass of livestock, poultry manure and straw to study the resource utilization and integration technology by division and classification. The SPSS regression analysis and integration were applied to analyze the economic benefits of the base period (2018) and the audit period (2020). The analysis gives an opportunity in rural areas to reduce chemical fertilizers, pesticides, electricity and coal cost in planting, and this paper opens a novel window for utilizing renewable energy resources and reducing carbon dioxide emissions.

Maltodextrin Use in Persistent Neonatal Hypoglycemia; Audit Report of a Single Center Experience

Background: Neonatal hypoglycemia is known to cause significant neuronal damage and poor neurodevelopmental outcomes. Consensus guidelines are lacking for the management of persistent neonatal hypoglycemia and hyperinsulinism which often requires high concentrations of dextrose and medications. Although used in the pediatric population with persistent hypoglycemia, only a few case reports are published regarding the use of Maltodextrin supplementation in persistent neonatal hypoglycemia due to transient hyperinsulinism. Objective: To audit the use of Maltodextrins in the management of persistent neonatal hypoglycemia due to transient hyperinsulinism in neonates. Audit design: A retrospective chart review (CERNER electronic data) of all cases with persistent neonatal hypoglycemia who received Maltodextrin supplementation for a period of 3½ years between July 2018 and December 2021. Results: A total of 18 neonates received Maltodextrin supplementation for neonatal hypoglycemia during the audit period. 16/18 (89%) neonates who received Maltodextrin supplementation were weaned off from intravenous dextrose within 1 week without major side effects or severe rebound hypoglycemia. Two out of 18 babies who received Maltodextrin needed Diazoxide supplementation for persistent hypoglycemia. Conclusion: The results of our audit are promising, yet further research and randomized controlled studies are needed to systematically evaluate the findings of this audit regarding Maltodextrin supplementation for the management of neonatal hypoglycemia with transient hyperinsulinism.

A file audit of gym usage in an Australian private inpatient psychiatric hospital.

This study aimed to determine the extent to which people admitted to a private psychiatric inpatient unit access and utilise the gymnasium and individualised coaching with an exercise physiologist (EP). An audit of the medical record of 100 consecutive discharges and 60 individuals referred to an EP during the audit period was undertaken. Selected demographic information, physical health status, psychiatric diagnosis and routinely collected outcome data were extracted from files. Twenty-four percent of people discharged from the hospital had documentary evidence of having attended the gym. These people were noted to have used the gym regularly and had an exercise prescription documented on discharge. Those with substance use disorder were more likely to use the gym than those diagnosed with an affective disorder. There were no significant differences in outcomes between those who were noted to exercise and those who did not. Those who may most benefit from coaching around exercise in the context of hospital admission are not presently the individuals most likely to be referred to an EP. Standardised procedures for assessment, referral, exercise prescription and ongoing monitoring of activity and outcomes are recommended across the care continuum.

Mapping pre-consumer food waste in quick service restaurants on a university campus: Two Australian case studies

Mapping and monitoring the process of pre-consumer food waste generation in the foodservice sector is needed to fully understand food waste, identify hotspots, and strengthen the evidence-base in this sector of the food supply chain. The purpose of this study was to validate a tool for separation and quantifying pre-consumer food waste in a quick service restaurant (QSR) setting, and to map the food waste generation process using statistical process control methodology. This included consideration of food waste categories and edible versus inedible waste. The study also explored key foodservice and menu practices which may impact food waste production. Food waste audits were undertaken in two food outlets (FOs) in an Australian university campus over a two-week operating period for each outlet using a direct weighing method. Foodservice operation and menu practices occurring in the outlets during the audit period were also recorded. These observations validated practices reported by the owner-manager of the FOs during interviews. The amount of waste collected separately from each outlet was analysed using statistical process control methodology. While each FO was treated as a separate case study, the same methodology was applied to each, allowing some comparison between outlets. Despite differences in foodservice style and menus, the average daily pre-consumer food waste produced from all food waste categories was approximately 25 kg for both outlets, with about 60% from inedible waste. This equated to approximately 5.5–6.1 kg of pre-consumer waste per full-time-equivalent employee (FTE) per day. Used coffee grounds was the largest single contributor of total pre-consumer waste for both FOs. Both FOs demonstrated compliance with Australian best practice in foodservice operations and menu design. The study concludes that the method used to separate pre-consumer food waste into different categories and quantify this waste was a practical tool for these QSRs and allowed researchers to validate both the separation process and the amount of waste collected. Analysis of data using statistical process control allowed differentiation between common and special cause of variations. These findings can help inform processes which generate food waste in these types of foodservice settings and assist with the development of food waste reduction initiatives.

Improving access to patient information leaflets utilising QR codes in patients undergoing emergency appendicectomy.

Abstract Background Informed consent is a cornerstone of ethical surgical practise. Patients undergoing emergency surgery have reduced time to consider their options when compared to the elective setting. Therefore, improving informed consent in this setting is critical. We aim to increase the provision of a pre-operative patient information leaflet (PIL) for patients undergoing an emergency appendicectomy by 50% over two audit cycles. Methods The same methodology were used for both cycles of this audit. Patients were identified through histopathology lists over a two week period. Medical notes were reviewed for documentation of provision of trust approved patient information leaflets. A QR code for an electronic version of the information leaflet was added to emergency clinic rooms, doctors handover rooms and the SHO on call bleep between audit periods. Results Empirical results from two audit cycles revealed that introduction of a QR code increased uptake from 0% of patients receiving the recommended appendicectomy leaflet, to 58%, achieving our aim. Conclusion The QR code provided a useful transportable resource, which was utilised by doctors. This provides scope for progression in provision of leaflet for other surgical issues, both in inpatient and outpatient settings, through utilisation of a QR code.

Door-to-Needle Time for Administration of Antibiotic in Children with Cancer Within the Golden Hour- an Audit from a Tertiary Cancer Hospital in a Low-Middle Income Country

Abstract Background Fever neutropenia (FN) is the commonest complication during treatment in children with cancer. Most guidelines recommend administration of intravenous antibiotics within 60 minutes of presentation to the Emergency Room (ER) to minimize life threatening complications of FN(1). We performed a 3-month audit at our ER to see if this target was being met(2). The departmental FN management policy was revised and implemented from February 2021 based on the prevailing hospital antibiogram. All children undergoing treatment in the Paediatric Oncology Department are provided with written FN Alerts/Advice (Fig. 1). All patient prescriptions include instructions on antibiotic choice and dosage. Annual educational sessions are held with the ER staff and Paediatric Oncology Residents. A stock of essential antibiotics is maintained in the ER. Methods All children on chemotherapy or radiotherapy presenting to ER with fever (≥38°C) either at home or documented at ER had blood counts and blood cultures sent both from a peripheral vein and the indwelling central venous device (if present). The first dose of antibiotics as prescribed was administered without waiting for the blood count report or assessment by the Clinician. Time of patient’s arrival at ER and time of administration of the first antibiotic dose were obtained from ER nursing records and patient drug cards. Data was entered prospectively within 24 hours and tabulated for analysis on Microsoft Excel. Fig.1: Fever Neutropenia Sticker on Patient File Results Eighty-four children presented with 129 episodes of fever during the audit period (1st April 2022-30th June 2022). Median age was 6.4 years (IQR 3.1,12). Median time interval from last chemotherapy was 6 days (IQR 2,10). All children reporting to ER were seen by a Clinician, with 106 (82%) episodes seen within 30 minutes of reporting (median 15 minutes, IQR 5,21). All children received initial intravenous antibiotics after blood sampling. Median door-to-needle time was 45 minutes (IQR 35,60 minutes) There were 2 deaths in this cohort, one due to cancer progression and the other due to an unidentified infection of the central nervous system. Conclusions Over 80% children received the first dose of antibiotics within the target of <60 minutes. There were no deaths attributable to sepsis. Though the outcome was excellent in this cohort, we need to analyse the reasons for delay in administration of the first antibiotic dose and take remedial measures to improve compliance.