To assess whether improvements in transurethral resection of bladder tumour (TURBT) quality achieved during the RESECT international study (ClinicalTrials.gov identifier: NCT05154084) were sustained over time following completion of the programme at our institution and to investigate their effect on disease recurrence. We conducted a prospective, observational monocentric cohort study at a tertiary university hospital. A total of 128 consecutive patients undergoing TURBT between March 2023 and June 2025 and meeting RESECT eligibility criteria were analysed. Four pre-defined surgical quality indicators-detrusor muscle sampling, completeness of resection, accuracy of operative documentation, and administration of single immediate intravesical chemotherapy (SI-IVC)-were compared across three institutional phases: pre-audit, prospective audit and post-audit RESECT periods. Recurrence-free survival (RFS) at follow-up was evaluated by cystoscopy and histological confirmation with TURBT. Detrusor muscle presence improved from 61.9% in the pre-audit phase to 70.7% during the prospective audit and 85.9% post-audit (P < 0.001). Completeness of resection documentation increased from 88.4% to 96.3% and 97.6%, respectively (P < 0.001), while documentation accuracy remained high across all phases (93.2%, 96.3%, and 96.1%). SI-IVC use rose from 0% in the first two phases to 25% after audit closure. Despite these improvements, RFS did not differ significantly between phases. Participation in a service-wide audit and feedback programme resulted in sustained improvements in TURBT surgical quality indicators after programme completion. This did not yield a detectable reduction in recurrence, highlighting the multifactorial nature of oncological outcomes in non-muscle-invasive bladder cancer. Further studies are required to identify which quality metrics most strongly influence long-term prognosis.

To reduce on-shelf wastage of Fresh frozen plasma (FFP) and Cryoprecipitate units, critical in blood product management given the substantial resources involved and demand-supply disparity in India. This audit aimed to identify and mitigate the causes of breakage in these units. A Prospective clinical audit was conducted at the tertiary care hospital Blood Centre from January to December 2024. The study comprised three stages: Baseline, Intervention, and postintervention using Plan-Do-Study-Act (PDSA) method. Study included all FFP and Cryoprecipitate prepared and stored during this period. Statistical analysis revealed a significant reduction in FFP and Cryoprecipitate breakage proportion from an intervention value of 2.09% to a post-intervention value of (1.03<, p< 0.001), and from a baseline of 2.66% to post-intervention (1.03%, p< 0.001). While the initial decrease from baseline (2.50%) to intervention (2.09%) was not statistically significant (p=0.21), wastage due to all other reasons demonstrated a statistically significant reduction from baseline (4.96%) to intervention (3.68%, p=0.04). Furthermore, the mean wastage of FFP and Cryoprecipitate bags attributable to both breakage and other reasons, showed consistent and statistically significant reductions across the study period (p= 0.012 and p=0.004 respectively for baseline to post-intervention changes, with Post-Hoc Analysis confirming p= 0.01 and p = 0.001). This audit provides a valuable blueprint for other blood centers, achieving a significant reduction in on-shelf FFP and Cryoprecipitate wastage (3.9% to 0.22%) via iterative PDSA. Optimal utilization requires staff training, SOP adherence and monitoring. Future efforts must disseminate these best practices and expand similar Quality improvement (QI) initiatives.

Early protocol computed tomography scan in asymptomatic high-risk patients diagnosed with pancreatic fistula after pancreatoduodenectomy: Results of a prospective audit.

Prospective audit and feedback (PAF) is a core antimicrobial stewardship strategy. Discontinuing PAF in favor of alternative interventions has not been previously evaluated. This descriptive study assessed changes in antimicrobial days of therapy per 1,000 patient days (DOTs/1,000 PD) following PAF removal at two urban hospitals. Preintervention PAF included daily review of broad-spectrum antibiotics and oral therapy transitions. Postintervention efforts emphasized system standardization, education, guideline optimization, and electronic medical record enhancements. Secondary outcomes included trends in antibiotics previously reviewed under PAF: antibiotics targeting methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa, carbapenems, and oral antibiotics. Hospital A demonstrated a change in the trend of DOTs/1,000 PD with a significant downward slope after PAF removal (-5.994; 95% CI -8.072 to -3.929; P < .001). Hospital B continued to down-trend postintervention. At hospital A, carbapenem use decreased significantly postintervention (slope change -0.117; 95% CI -0.198 to -0.036; P = .007), with no changes in anti-MRSA or anti-pseudomonal agents. Hospital B demonstrated increasing use of anti-MRSA (slope change + 0.394; 95% CI 0.198 to 0.589; P < .001), anti-pseudomonal (slope change + 0.378; 95% CI 0.075 to 0.681; P = .016), and carbapenem agents (slope change + 0.124; 95% CI 0.020 to 0.228; P = .021). No changes were observed in oral antibiotic use or C. difficile rates. Shifting stewardship resources away from PAF did not increase total antibiotic use trends. Broad-spectrum antibiotics increased modestly with unclear clinical significance (≤1.3 DOT/1,000 PD). Antimicrobial stewardship strategies, beyond PAF, should continue to be assessed to maximize effectiveness relative to effort.

Flexible ureteroscopy (F-URS) with suction technology has become a minimally invasive surgery for the management of renal stones. While the Flexible and Navigable Suction Ureteral Access Sheath (FANS) and Direct In-Scope Suction (DISS) ureteroscopes individually have proven benefits and restrictions, there is no dedicated research if integrating both these technologies can complement the limitations of each to improve suction F-URS outcomes. This audit introduces the Flexible Integrated Retrograde Suction-Ureteroscopy Technique (FIRST) procedure, which integrates FANS with a DISS ureteroscope, and compares its outcomes against DISS combined with a conventional ureteral access sheath (C-UAS). This prospective audit enrolled 64 adult patients undergoing F-URS with a DISS ureteroscope between August 2024 and October 2025 at 2 institutions. Patients were allocated to DISS with FANS (Group 1, n = 37) or DISS with C-UAS (Group 2, n = 27) based on surgeon discretion and device availability. The primary outcome was 30-day stone-free rate (SFR) assessed by non-contrast CT scan (single fragment up to 2mm). Secondary outcomes included perioperative complications, renal function, and 3-month residual fragment rate, and the surgeon-reported ergonomics of procedures. Despite significantly greater stone burden in Group 1, the FIRST procedure achieved a superior 30-day SFR of 83.8% versus 70.4% in Group 2, with zero-residual-fragment status in 72.9% versus 48.1% of patients, respectively (p < 0.001). At three months, zero residual fragments were detected in all patients in Group 1 compared to 22.2% in Group 2 (p < 0.01), translating into zero reinterventions in Group 1. Surgeon-reported ergonomics, intraoperative visibility, and simultaneous DISS-laser manipulation were rated significantly superior in Group 1. Overall 30-day complication rates were comparable between groups (18.9% vs. 22.2%), with no high-grade (Clavien ≥ 3) complications and preserved renal function in either cohort. The FIRST procedure using this integrated suction technique can potentially give 100% SFR with significantly improved ergonomics with negligible complications. These findings support further investigation of the integrated FIRST procedure in routine and anatomically complex renal stone disease.

What does respiratory physiotherapy look like for patients requiring prolonged mechanical ventilation in Australia? A prospective multicentre audit of practice.

Carbon footprint of routine endoscopic procedures - a comprehensive assessment in three US endoscopy units.

Pelvic exenteration (PE) has evolved from a palliative "procedure of desperation" into a potentially curative operation for selected patients with locally advanced or recurrent pelvic malignancy. Christchurch Hospital has delivered PE for more than three decades and has been an active contributor to the international development of these procedures. Retrospective description of the Christchurch PE programme and its evolution since the mid‑1990s, contextualised against contemporary multicentre evidence, is provided. Service components evaluated include multidisciplinary governance, patient selection, operative strategies for posterior and lateral compartment disease (including sacrectomy), peri‑operative optimisation and survivorship pathways. Since 1995, Christchurch has undertaken over 520 multivisceral pelvic resections. Centralisation of complex patient care supports operative volume, consistency of team performance and benchmarking against international standards. Prospective audits with collaborative international research have strengthened the understanding of what drives good oncological outcomes (particularly the impact of R0 resection), as well as morbidity patterns in high‑risk sub-groups, feasibility of repeat PE and patient‑reported outcomes including quality of life. A centralised multidisciplinary programme can safely deliver ultra‑complex pelvic oncology surgery. Continued international collaboration and systematic capture of patient‑reported outcomes will define the next phase of PE service development.

Background:Antimicrobial stewardship programs (ASPs) promote optimal antimicrobial use in pediatrics; however, data describing structure, personnel effort allocation, and activity distribution across regular and after-hours workflows remain limited.Methods:We conducted a cross-sectional survey of pediatric ASPs across the U.S. from September to October 2024 using ASP/ID-related listservs. Respondents reported institutional structure, personnel effort allocation, initiatives, and participation in an after-hours ASP on-call model, with additional details from programs reporting on-call participation.Results:Twenty-two pediatric ASP responses were included, most from academic medical centers (81.8%) and programs covering 101–250 beds (41%). Median physician full-time equivalents (FTEs) increased with institutional size, ranging from 0.1 for institutions with < 100 beds to 0.8 for those with >500 beds. Pharmacist FTEs were a median of 1 for institutions with ≤ 500 beds and increased to 2.25 for programs >500 beds. Most programs reported to Quality and Safety (45%) or discipline-specific departments (41%), with funding primarily attributed to Pharmacy (73%). During regular working hours, nearly all programs performed prospective audit and feedback (100%), responded to ASP-related inquiries (95.5%), and facilitated antimicrobial de-escalation (90.9%). Six programs (27.4%) reported participation in an ASP on-call model, most commonly providing remote coverage during evenings, weekends, and holidays. After-hours activities were largely limited to time-sensitive interventions, including preauthorization and responding to inquiries.Conclusions:Pediatric ASPs demonstrate variability in structure, personnel effort allocation, and stewardship activities. ASP on-call coverage remains uncommon and is typically focused on time-sensitive interventions, reflecting targeted deployment of stewardship resources outside regular working hours.

Resuscitation plans document the mutually agreed medical care of hospital inpatients in an acute deterioration, including decisions regarding cardiopulmonary resuscitation (CPR), rapid response calls (RRCs), and other specific interventions. The aim of this study was to examine the resuscitation plan completion rate among all medical oncology inpatients after the introduction of a 100% completion target. We concurrently examined the outcomes of medical oncology inpatients subject to a RRC to investigate medium- and long-term patient outcomes. A prospective real-time longitudinal audit of resuscitation plan completion was conducted of all medical oncology admissions over 3 months. Completion of a resuscitation form at any time, and within 72 h, was recorded. RRC information was obtained from the preceding 6 months. RRC data included event time and trigger, patient tumor type and treatment intent, available resuscitation plan at RRC, patient disposition after RRC, survival to discharge, and to future cancer treatment. Of 326 hospitalizations, 60% included a completed resuscitation form and 56% within 72 h. There were 53 RRCs in 39 individual patients. Most RRCs were after hours (64%) and without an available resuscitation plan (92%). Additionally, 91% of RRCs were in patients receiving palliative cancer treatment; 53% did not survive to discharge, and 76% received no further systemic cancer treatment. Resuscitation plan completion remains significantly below the aspirational 100% and requires targeted implementation strategies. A proportion of oncology patients receiving palliative cancer treatment continue to be managed in hospital without a resuscitation plan and undergo RRCs despite a poor prognosis.

Physiotherapy at night: A multicentre prospective audit of respiratory-based physiotherapy services provided at night in Queensland.

Feasibility and compliance with quality indicators for pediatric respiratory care in Jordanian emergency departments: A mixed-methods study.

Since 2020, the UK National Institute for Health and Care Excellence (NICE) recommends screening for Lynch syndrome in all people newly diagnosed with endometrial cancer. Screening involves tumour testing for loss of the mismatch repair (MMR) proteins using immunohistochemistry (IHC), MLH1 methylation testing and germline sequencing for Lynch syndrome according to a diagnostic algorithm. Here we review adherence to NICE guidance at a gynaecological cancer centre in North-West England. We conducted a prospective audit of Lynch syndrome screening for consecutive patients newly diagnosed with endometrial cancer discussed at the gynaecological oncology multidisciplinary (MDT) meeting. We recorded adherence with the NICE recommended diagnostic algorithm, testing turnaround times and the impact of gynaecology-led genetic testing (mainstreaming) on diagnostic intervals. Between November 2021 and November 2023, 421 new endometrial cancer patients were discussed at MDT. Overall, 96.9% (408/421) underwent IHC and 26.0% (106/408) were MMR deficient, mostly due to MLH1 hypermethylation (17.4%, 71/408). In total, 7.1% (29/408) had MMR deficiency not due to MLH1 hypermethylation (25/408 had MSH2/MSH6/PMS2 loss and 4/408 were non-hypermethylated) that required germline testing for Lynch syndrome, and 3.2% (13/408) had Lynch syndrome. Only 19/27 (70.4%) with positive tumour triage underwent Lynch syndrome testing (four declined and four died before testing). The median time from tumour MMR IHC results to germline test result was 121 days (IQR 103, 133) with gynaecology-led testing compared with 278 days (IQR 183, 476) with testing organised by clinical genetics. The prevalence of Lynch syndrome in our unselected endometrial cancer population was 3.2% but not everyone at risk was tested. Some declined germline Lynch syndrome testing due to a lack of at-risk family members and delay getting their genetic appointment. A significant minority died before they could be offered or receive Lynch syndrome testing. We recommend gynaecology-led germline testing and referral to clinical genetics only patients with confirmed Lynch syndrome. This approach would ease the burden of an already overstretched genetics service while promptly identifying Lynch syndrome in high-risk patients. This in turn enables timely colorectal cancer surveillance and cascade testing of at-risk family members.

Objective:The current study was done to evaluate the impact of a plan-do-check-act (PDCA)-based AMS program implemented at a tertiary trauma center.Setting/Patients:Inpatients admitted to an Advanced Trauma Centre of a tertiary care hospital in North India.Methods:This implementation research study was conducted in four phases from March 2019 to November 2024. The AMS strategies included prospective audits, feedback mechanisms, education, and multidisciplinary collaboration. Descriptive statistics were used for antibiotic prescription practices, adherence to guidelines, and patient outcomes. Metrics for antibiotics utilization and appropriateness of prescription were the key performance indicators analyzed.Results:A total of 767 patients were enrolled during this period. The practice of antibiotic prescription changed from being prophylactic to culture-based—increasing from 0.7% in phase 1 to 21.4% in phase 4. Compliance to feedback increased from 75.8% in phase 3 to 90.7% in phase 4. There was a fall in aggregate defined daily dose to 658.4, from 808.2 per 1000 patient days, and length of therapy also improved. There was a marked increase in the number of culture-based interventions. The educational programs and multidisciplinary team rounds further reinforced the practice of AMS.Conclusions:The PDCA cycle significantly improved the use of antimicrobials, adherence to treatment guidelines, and patient outcomes in a resource-constrained setting. This approach provides a scalable model for implementing AMS in surgical units despite challenges such as limited microbiological resources.

BackgroundSafe discharge from the hospital is a critical component of patient safety and affects continuity of care. Following discharge, surgical patients remain at risk of developing some complications and may be uncertain about their expected recovery. Clear, structured discharge information will help them understand the post-discharge pathway, recognize warning symptoms, and seek timely medical review. Safety netting advice is, therefore, important and essential in reducing preventable harm and avoidable readmissions. This study aimed to enhance patient safety and continuity of care at Queen Alia Military Hospital (QAMH) by improving the quality of electronic surgical discharge summaries, with a specific focus on safety netting. The objectives included assessing baseline completeness of 100 summaries via a 12-parameter checklist; identifying clinical and systemic barriers through a resident survey; evaluating the impact of educational workshops and standardized templates via a 106-record re-audit; and determining the prevalence of safety-netting gaps regarding red-flag symptoms and pending histopathology results across both audit cycles.MethodologyA prospective clinical audit loop was conducted by utilizing retrospective electronic record reviews for data collection at QAMH by evaluating the completeness of surgical discharge summaries using a 12-parameter checklist. Following a baseline audit of 100 consecutive discharges (December 2025 to January 2026), a multimodal intervention was implemented in February 2026, comprising resident educational workshops, standardized electronic templates, and dedicated documentation time. A resident survey (n = 15) identified systemic barriers, primarily time pressure and lack of training. A re-audit of 106 records (March 2026) was conducted to measure improvement. Data were analyzed via descriptive statistics and Fisher’s exact test, with inter-rater reliability ensured by independent specialist review.ResultsIn a review of 100 adult surgical discharge summaries, overall completeness was moderate, with most summaries documenting only 5-7 out of 12 required items. Very few reached high completeness (8-9 items), and none included key safety-netting information such as red-flag symptoms, clear advice on when to seek help, or pending histopathology results. Statistical analysis showed that some sections tended to be completed together, such as final diagnosis with discharge condition, and procedures with discharge medications. However, other areas showed inconsistent or uneven documentation, with hospital course and physical assessment often missing when other sections were well documented, highlighting variability in how different parts of discharge summaries are completed. The re-audit demonstrated a substantial shift in documentation practices, with mean completeness rising to 77.04%, with core clinical reporting exceeding 90% compliance.ConclusionsThe implementation of clinical audit loops successfully standardized the reporting of objective clinical data, leading to a significant increase in the quality of discharge summaries. The dramatic rise in documented physical assessments and test results suggests that previous interventions effectively integrated these requirements into the clinical workflow. Nevertheless, a safety-netting gap persists. Future quality improvement cycles should prioritize the inclusion of patient-centered instructions.

Anaesthetic gas emissions in a tertiary hospital in Pakistan: Behavioural drivers versus technological solutions

Acute kidney injury in children is a serious but often overlooked condition in low-resource settings. In Rwanda, although referral hospitals provide advanced care, most children are managed at district hospitals, where limited diagnostic services and low provider awareness may delay diagnosis. We assessed healthcare providers' knowledge of pediatric AKI, audited real-world case management, and evaluated whether a brief training intervention could improve early detection and care. We conducted a mixed-method study in six Rwandan hospitals affiliated with the University Teaching Hospital of Kigali from 2024 to 2025. A cross-sectional survey assessed provider knowledge, followed by retrospective and prospective case audits of pediatric AKI management. Cases aged 1 month to 14.9 years were screened using serum creatinine ≥ 1.0mg/dL, and 155/156 met KDIGO Serum Criteria for AKI. A KDIGO-based educational workshop was delivered on April 25, 2025; patients admitted before formed pre-intervention cohort (n = 138) and post-intervention cohort (n = 18). Care quality was assessed using nine indicators adapted from the Recognition-Action-Results framework. Multivariable and stratified analyses were performed. Among 166 providers (65.7% female; 51.2% nurses), the mean knowledge score was 2.1/5.0 (42%), with only 3.6% achieving > = 80%. Knowledge gaps were consistent across professional categories and hospitals, although 89.8% expressed willingness to adopt AKI guidelines. In the 156 pediatric cases (mean age was 6.6 +/- 5.3 years; 54.5% male), 76.3% presented with KDIGO Stage 3 AKI, most commonly associated with acute gastroenteritis (33.3%). Baseline care quality was poor with low documentation of staging (5.8%), urine output monitoring (3.6%), and follow-up creatinine testing (27.5%); however, laboratory investigations were performed in 87.7% of cases. After training, follow-up creatinine monitoring increased modestly to 33.3%. Composite care quality showed non-significant improvement (40.6% vs. 44.4%; OR 1.17, 95% CI 0.44-3.15; p = 0.802). Overall mortality was 9.6% (15/156) with hypovolemic shock (OR 8.73, p = 0.008), severe dehydration (OR 5.29, p = 0.009), and hypernatremia (OR 4.18, p = 0.045) as independent predictors. Pediatric AKI remains underrecognized in Rwandan district hospitals, with critical gaps in staging and monitoring. Training improved selected practices but did not translate into improved outcomes. Sustained improvements require mentorship, standardized protocols, and system-level support. Larger prospective studies are needed to confirm impact.

Community-acquired pneumonia (CAP) remains a major cause of pediatric morbidity and antibiotic exposure in low- and middle-income settings. This prospective clinical audit evaluated antibiotic prescribing patterns, pathogen distribution, and short-term outcomes among 300 children aged 3 months to 5 years managed for CAP at Zawia Medical Center, Libya, during 2025. Fever (93.3%), cough (89.0%), and difficulty breathing (72.7%) were the predominant presenting features; 34.3% met the World Health Organization criteria for severe pneumonia. When microbiology was available, Streptococcus pneumoniae (38.0%) and Haemophilus influenzae type b (22.0%) were the leading pathogens. Amoxicillin was the most frequently prescribed empirical antibiotic (39.0%), followed by amoxicillin-clavulanic acid (18.7%) and ceftriaxone (14.0%). Oral therapy was used in 68.0% of children and intravenous therapy in 32.0%. Treatment duration was 6–10 days in 61.0% of cases. Prescribing was considered rational in 70.7% of records, while 29.3% showed deviations from preferred practice. Clinical improvement was documented in 88.3% of patients, readmission within 30 days occurred in 9.3%, and mortality was 2.3%. The findings suggest generally acceptable adherence to pediatric CAP treatment principles, but they also identify a substantial opportunity to strengthen antimicrobial stewardship, reduce unnecessary broad-spectrum use, and standardize duration of therapy.

Background and Objectives: Thrombocytopenia complicates 6.6-11.6% of pregnancies. While gestational thrombocytopenia (GT) is usually benign, etiologies such as immune thrombocytopenia (ITP), preeclampsia, and HELLP syndrome require individualized management. This study aimed to characterize the etiological spectrum, maternal peripartum hematologic outcomes, blood product utilization, and mode of delivery in a tertiary-center cohort of thrombocytopenic pregnancies and to assess whether platelet count should influence delivery mode decisions. Materials and Methods: This retrospective cohort study included 137 thrombocytopenic pregnant women at a tertiary center (2010-2019), categorized by etiology and severity. Peripartum hemoglobin, hematocrit, and platelet counts were compared between delivery groups. Blood product utilization was recorded and analyzed using t-test, ANOVA, chi-square, Fisher's exact, and Fisher-Freeman-Halton tests; binary logistic regression was used for multivariable analysis. Results: GT (43.1%) and ITP (32.1%) were the most prevalent diagnoses; cesarean delivery rate was 52.6%. Postpartum Hb was higher in the vaginal delivery group (10.24 ± 1.28 vs. 9.80 ± 1.26 g/dL; p = 0.003), while platelet counts were paradoxically lower (p = 0.039). Platelet transfusion rates did not differ significantly between delivery modes (23.1% vs. 27.8%; p = 0.621). Severe thrombocytopenia required platelet transfusion in 92.6% of cases versus 11.6% (moderate) and 0% (mild) (p < 0.001). RBC transfusion was highest in gestational hypertensive disease (41.2%) versus GT (5.1%) and ITP (2.3%) (p < 0.001). General anesthesia was used in 75% of cesarean cases. Conclusions: Delivery mode in thrombocytopenic pregnancies should be guided by obstetric indications, not platelet count alone. Although postpartum platelet counts declined more steeply after vaginal delivery, this did not increase transfusion requirements. Gestational hypertensive disorders carried the greatest hemorrhagic burden, highlighting the need for etiology-specific multidisciplinary planning. The high general anesthesia rate warrants prospective institutional audit of anesthetic decision-making protocols to determine adherence to current neuraxial anesthesia thresholds. This study is limited to maternal peripartum hematologic outcomes; neonatal outcomes were not captured and should be addressed in future prospective research.

This audit aimed to assess compliance with British Orthopaedic Association Standards for Trauma (BOAST) for paediatric forearm and wrist fractures across UK NHS hospitals and identify targets for improvement locally and nationally. This was a prospective, multicentre observational audit of BOAST standards for the Early Management of the Paediatric Forearm Fracture guideline. Consecutive patients aged under 16 years presenting with a forearm or distal radius fracture over a two-month period were included with follow-up to eight weeks post injury. Data were collected to assess each of the BOAST standards for practice. Percentage compliance with all standards was calculated for each hospital. Data from 1,699 patients across 53 hospitals were included. The mean age was 9.7 years (SD 3.6), and 37% (n = 636) were female. Overall, 60% of fractures (n = 1,023) were metaphyseal distal radius fractures. A total of 577 patients (34%) underwent manipulation with the majority initially reduced in the Emergency Department (ED) (n = 423, 73%); 89 (21%) required subsequent theatre manipulation. The median time to first manipulation in the ED was two hours 43 minutes (IQR 1 hr 43 mins to 4 hrs 4 mins) and 18 hours 47 minutes (IQR 13 hrs 48 mins to 24 hrs 2 mins) when first manipulation was performed in theatre. Overall compliance with BOAST standards was 63%, with 20% of patients (n = 85) having pain scores documented, 51% (n = 217) having a complete neurovascular assessment, and 23% (n = 95) receiving analgesia and a patient information leaflet on discharge. This study highlights variability in managing paediatric fractures despite established standards. In line with recommendations, a high proportion of reductions are now being performed in EDs. Particular areas requiring improvement are the management of paediatric pain, documented assessment of neurovascular status, and the provision of patient information. We recommend that hospitals review their current practice and ensure that local protocols are in place to promote the provision of optimal care for this patient group, and to minimize the impact on operating theatre capacity.