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MANAGEMENT OF HEAD INJURY IN THE HOSPITAL SETTING
  1. A Carnachan,
  2. R Savage,
  3. E Waters,
  4. F Elwen
  1. Emergency Medicine, Guys and St Thomas NHS Foundation Trust, London, UK

Abstract

Objectives & Background 700,000 people visit Accident and Emergency (A&E) with head injuries annually. NICE have clear guidance as to how these patients are managed in hospital, as outlined below:

  • A standard head injury proforma must be used in all clinical departments.

  • Indication for a CT head in 1 hour, or 8 hours.

  • Observations must be performed every 30 minutes for 2 hours, every hour for 4 hours, then 2 hourly.

  • On discharge, verbal and printed advice must be given.

Guy's and St Thomas' Foundation Trust (GSTT) has developed a specific head injury proforma, which aims to implement these guidelines. Advice on the management of complex head injury cases is sought from neurosurgery at King's College Hospital.

Our study aims to determine how well head injuries are managed at GSTT in accordance with NICE guidelines, to identify and implement service improvements where necessary.

Methods A search was performed on Symphony (A&E tracking system) for all codes to find adult (>18 years) head injury cases during the month of December 2015. Cases were investigated using paper notes, Symphony, e-noting, and EPR, and data was analysed using excel.

Results 251 head injury cases were seen in A&E in December 2015. The GSTT A&E head injury proforma was completed in only 9 cases.

A CT head was performed in 47 cases, of which 5 revealed an abnormality. 32 patients had an indication for CT in 8 hours. 12 did not receive scan at all, the remaining 20 all received scans within 8 hours. There were 27 patients who required a CT in 1 hour; 15 of these were performed in 1 hour after being seen (average time 59 minutes). 3 were not performed.

27 patients were admitted: 19 under medical teams, 3 under surgical teams, 5 under specific teams for other injuries. 1 patient was transferred to King's College Hospital. 5 patients were discussed with King's College Hospital, and in 4 cases advice was followed correctly.

Only 13 out of 27 patients admitted had neurological observations recorded in e-noting.

Conclusion Although a relatively small study, it has highlighted the need for further education and training of staff in regards to the head injury guidance that exists within the trust, specifically in regards to comprehensive documentation.

There will be a focus on promoting the use of the head injury proforma in A&E, and making it readily available on all wards. With collaborative working with IT on e-noting, the plan is to ensure observations can be recorded and accessed quickly and easily.

  • Trauma

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