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ABSTRACT
Objective Head injury is a common presentation to the emergency department yet adherence to guidelines for management is suboptimal. Our study assesses adherence to National Institute for Health and Care Excellence (NICE) computed tomography (CT) head guidelines at a teaching hospital in the United Kingdom. It critically evaluates the efficacy of interventions.
Methods We performed a quality improvement project to improve adherence to NICE CT head scan guidelines following head injury. Data was collected over one-month in 2014, and 2017. Interventions included education of the multidisciplinary team, information sheets, team engagement and tri-annual education sessions for junior doctors. The success of these interventions in the adult population was assessed objectively during the second cycle and subjectively via a junior doctor survey.
Results 171 patients were included in the study. Following interventions, there was a statistically significant decrease of 23% in the number of CT heads requested with no clear indication (P = 0.00027). The mean time to scan for the one-hour indications decreased from 73 to 55 minutes. The mean time to report all scans decreased from 89 to 57 minutes. The survey results were encouraging.
Conclusion Adherence to NICE guidelines for head injury is inadequate but can be improved by interventions.
Acknowledgments
We wish to acknowledge A Bowes, M Kolanko and M Makwana who helped with part of the data collection.
Authors contributions
LA and LH wrote the paper, performed data collection and analysis, and contributed equally to the project. NA conceived the project and supervised the write up. PC collected data and helped develop the interventions.
Disclosure statement
No potential conflict of interest was reported by the authors.