Introduction: Timely assessment and management are essential in high-quality paediatric emergency care. Time-based clinical quality indicators provide objective measures of efficiency , patient flow , and safety . This clinical audit assessed selected time-based quality indicators in the Paediatric Accident & Emergency (A&E) Department of Sirimavo Bandaranaike Specialized Children’s Hospital, Peradeniya. Objectives: To evaluate selected time-based clinical quality indicators in the Paediatric A&E Department, including time to initial nursing assessment, total duration of stay in A&E, time to medical assessment, and admission patterns across different shifts. Methods: A retrospective clinical audit was conducted over a 10-day period (14–23 December2025). All presentations were included, excluding on-arrival deaths. Data extracted from registration, triage, and clinical records. Admissions were categorized by shift, and descriptive statistics analyzed. Results: Sixty paediatric patient records were analyzed. Majority males (61.7%), with agesranging from 1 month to 13 years. The most admissions occurred during the morning/day shift (60.0%). The mean time to initial nursing assessment was 5.6 minutes (range: 0–15 minutes) and was consistent across all shifts. The mean total duration of stay in A&E was 74.2 minutes (range: 13 minutes to 3 hours 45 minutes). Documentation of medical assessment times wasincomplete, limiting detailed analysis. No patients left against medical advice or re-attended within seven days. Conclusions: This audit demonstrates timely initial nursing assessment and acceptablepatient flow in the Paediatric A&E Department. However, incomplete documentation of medical assessment times highlights an important area for improvement. Adherence to standard documentation is essential to quality improvement.