Objectives Our Regional Children’s Hospital increased admission cut-off age for young people from their 14^th to their 16^th birthday at the onset of the Covid-19 pandemic. We wished to determine implications of this change on admissions, resources, staff, young people and their parents/guardians. We wished to assess how youth friendly our service was and identify improvement areas.

Methods We collected data on admissions of young people aged ≥14years to our regional children’s hospital mid-April to mid-August 2020. We recorded presenting complaint, diagnosis, resource use, admission duration and follow up. We met clinical staff to ascertain resultant challenges. We electronically surveyed staff, young people and their parents/guardians to determine how youth friendly we were using Department of Health England Refreshed ‘You’re Welcome’ criteria 2017 and identify improvement areas. Respondents had an opportunity for qualitative feedback.

Results 104 admissions (>14years) in 4 month period: Average age 14.8years. Modal stay 1 day. 78% outside 9–5pm most via emergency department. 43% medical, 20% surgical, 37% specialities. 42% had allied health professional input most frequently crisis mental health team. 65% required follow up. Young people most commonly presented with abdominal pain and mental health presentations were the most frequent discharge diagnosis.

Staff survey 95 clinical staff responded. 88% had prior experience managing patients >14years. 85% were aware of confidentiality. 94% felt additional adolescent training would or may be beneficial. Staff requested training on mental health, communication, consent/capacity/legalities/safeguarding and empowerment/engagement. Practical issues identified included patient placement, challenging behaviour, equipment size and access to mental health and adult services.

Parent/guardian survey 37% of admissions. 100% felt their young person was comfortable. 97% felt their young person was involved. 91% felt they were involved. 94% felt patient communication was good. 88% felt the hospital was accessible. 90% felt facilities were age appropriate. 97% would prefer Paediatric admission for their young person over an adult hospital. 75% were advised of confidentiality rules. 58% recalled their young person being offered time with their doctor alone.

Young People survey 27% of admissions. 88% felt the ward was private. 80% felt comfortable. 85% had a parent/guardian stay. 52% felt there were enough age-appropriate activities. 52% received written information. 88% felt involved. 84% felt comfortable asking questions. 83% thought explanations were good. 78% had the opportunity to talk to their doctor alone. 40% had lifestyle issues discussed. 80% would prefer children’s over an adult hospital.

Of those patients and parents/guardians surveyed 100% would recommend the service to family and friends. All groups provided useful qualitative feedback.

Conclusions Increasing the admitting age during covid-19 onset brought extra resource requirements and challenges to our paediatric service. Mental health was a significant component of service use. In spite of challenges young people and their parents/guardians reported good care during their inpatient stay. Key areas identified for improvement include having specialist adolescent inpatient provision, greater integration with mental health services, additional staff training and better availability of age and size appropriate equipment, facilities, expertise and estate.