meningococcal disease in the UK in under-19s in 2010) but carry high mortality (10% quoted by NICE) and morbidity. Getting good quality care for these patients is in everyone's best interests. How? The quality standard covers 14 quality statements, 10 of which are directly related to or raise issues relevant to ED care. Each statement sets a standard of care with the aim of assessing local practice and expressing results as a proportion receiving care to the suggested standard. I haven't gone mad: the numbering corresponds with the numbering in the NICE document (so number 6 is missing). This is, on the surface, common sense. NICE recognises that not all children with a temperature and in a bad mood have invasive meningococcal disease, and conversely not all children who are diagnosed with invasive meningococcal disease present with fever, vomiting and a purpuric rash. They may not look particularly unwell to begin with; in fact, back in late 2011 I saw an alarming case where a child with a temp had been admitted to the observation ward, had some vomiting and diarrhoea, normal WCC and CRP of 4. At the time her purpura appeared (approx 11h after her attendance at PED), her EWS had been "green" for more than four hours and it was Mum's assertion that she "just wasn't right" combined with a blood glucose of 2.9 that had made me hang on to her a little longer. She grew Neisseria meningiditis from the blood culture taken at the same