{
  "abstract": "Aims and Objectives Paracetamol overdose is a common presentation among paediatric patients in emergency departments. Standard management traditionally involves a 21-hour intravenous N-acetylcysteine (NAC) regimen. However, the Scottish and Newcastle Acetylcysteine Protocol (SNAP) delivers the same total NAC dose over 9 hours with comparable efficacy and fewer anaphylactoid reactions. By implementing the SNAP regimen, we aimed to reduce hospital length of stay for paediatric patients receiving NAC after paracetamol overdose.Method and Design We employed iterative Plan–Do–Study–Act (PDSA) cycles to implement a series of interventions. A local guideline was developed based on RCEM, RCPCH, and TOXBASE recommendations, in consultation with the Institute of Liver Studies at King’s College Hospital. To promote awareness and adoption locally, the guideline was disseminated via a team read to emergency department (ED) and acute paediatric staff, and structured teaching sessions were delivered to both paediatric and ED trainees. Additionally, a summary poster was displayed in the paediatric ED. We retrospectively measured the average length of stay for our study population and Statistical Process Control (SPC) chart analysis was carried out to identify outliers.Results and Conclusion A total of 72 patients were identified during the study period (44 pre-intervention, 28 post-intervention). SPC chart analysis identified 10 statistically significant outliers, all attributable to prolonged NAC treatment or complex safeguarding needs. In the post-intervention period, there was 100% compliance with the new guideline, and the mean hospital length of stay was reduced from 45 hours to 33 hours, representing a 27% reduction. No adverse events were noted in the pre- or post-intervention group.In conclusion, implementation of the SNAP regimen for paediatric paracetamol overdoses, supported by a structured quality improvement approach, significantly reduced hospital length of stay without an increase in adverse events. Wider adoption of SNAP could improve patient flow, reduce bed pressures, and enhance patient experience in paediatric emergency care.",
  "authors": [
    {
      "affiliations": [
        "Cambridge University Hospitals NHS Foundation Trust"
      ],
      "name": "Daniel Worley"
    },
    {
      "affiliations": [
        "Cambridge University Hospitals NHS Foundation Trust"
      ],
      "name": "Sabih Ul Hassan Syed"
    },
    {
      "affiliations": [
        "Cambridge University Hospitals NHS Foundation Trust"
      ],
      "name": "Robert Smyth"
    }
  ],
  "title": "3885 Oh, SNAP! reducing length of stay in paediatric paracetamol overdoses",
  "uid": "291ef9b3-3d1c-5187-9275-e528ec3a5c5c"
}