Elsevier

Injury

Volume 34, Issue 11, November 2003, Pages 853-856
Injury

Head injuries: a prospective observational study evaluating the potential impact of the Galasko report on Accident and Emergency departments

https://doi.org/10.1016/S0020-1383(03)00061-5Get rights and content

Abstract

In June 1999, the Galasko report of the Royal College of Surgeons of England recommended that in the next 5 years, the Accident and Emergency (A&E) departments should admit and supervise head-injured patients for up to 48 h. A prospective observational study was carried out for a 6 weeks period at the A&E department of Birmingham Heartland’s Hospital to identify the potential impact of implementation of the Galasko report. The cost implications of this perceived additional workload were considered.

Of the 786 head-injured patients seen during study period, 665 (85%) were discharged home directly from the A&E department. Of the remaining 121 patients, who were hospitalized, 76 (63%) were admitted to the A&E observation ward (AEOW) and 19 (16%) patients were admitted to a paediatric ward. All of these patients were discharged home within 24 h. The remaining 21% patients were admitted to other specialities and had prolonged stays in hospital. All of the 9% of the patients admitted under orthopaedics would have been admitted to the AEOW if the Galasko recommendations were implemented leading to an extra 22 bed days over the 6 weeks study period. The estimated annual cost of admission alone for these patients would be £38,200. Our study has demonstrated an expected additional workload and cost implications on a single A&E department.

Introduction

In the UK, one million patients with head injuries attend Accident and Emergency (A&E) departments each year [4]. Of these, 800,000 have a minor injury, and 80,000 are admitted to hospitals [3].

The management of isolated head-injured patients admitted to hospitals without neurosurgery on site has traditionally been carried out by various specialities including general surgery (55%), orthopaedics (30%) and other specialities (15%) [6]. In order to streamline the management of head-injured patients, The Royal College of Surgeons of England set up a multidisciplinary working party under the chairmanship of Galasko in 1997. The Galasko report identified that head-injured patients were not receiving consistent and optimal care [6]. The report concluded that the present system of care for the provision of services to patients with head injuries is inconsistent and recommended a strategic plan that should be implemented over next 5 years as an urgent quality issue.

The report’s main recommendations are summarised in Box 1.

The objectives of this study were to evaluate the current workload of a single Accident and Emergency department with regard to the management of head-injured patients and to determine the likely impact of the Galasko recommendations to future resource utilization on this department.

Section snippets

Methods

A prospective observational study was carried out over a 6 weeks period starting on 1 November 1999 at the A&E department of Birmingham Heartlands Hospital. This is a large urban teaching hospital with over 90,000 new attendances per year. The department has an adjacent eight-bedded observation ward where head-injured patients are currently admitted for up to 24 h under the care of the A&E team. The current guidelines for admission of head-injured patients to this unit are shown in Box 2.

Other

Results

During the study period, a total of 786 head-injured patients were seen in A&E department, representing 5.2% of all new attendances. Of the 786 head-injured patients seen, 665 (85%) were discharged home from the A&E department. Therefore, we observed the progress of 121 (15%) consecutive patients who were admitted to hospital after head injury.

Table 1 shows the distribution of all head-injured patients admitted by specialities during the study period.

All patients admitted to the AEOW and

Discussion

Our study looked at the potential impact of Galasko recommendations on the workload of an A&E department, which already has an observation ward in place. Over the 6 weeks study period, we found that the 11 patients admitted to orthopaedics would have been admitted to AEOW for first 48 h of their admission. This would have resulted in 3–4 extra bed days per week during the study period (191 extra bed days a year).

In order to calculate a projected financial cost to provide this additional level of

Conclusions

The Galasko report accepts the need for a significant increase in resources for both A&E departments and Neuroscience units. We have studied our practice at present so that we can produce an “evidence-based” evaluation for the resources that would be necessary to fulfil the extended role envisaged by the Galasko reforms. It is vital that these resources are secured before the speciality of A&E medicine takes on this additional role.

Acknowledgements

We would like to acknowledge the assistance of Mrs. Sue Ellis, who collated the data for this study. M.A.C. initiated the study and contributed to the study design, analysis and interpretation of the data, over-saw data collection and wrote the paper. T.S. and L.W. collected the data and contributed to the study design. A.F.M. contributed to study design, and helped in editing the paper. C.P. and A.B. provided core idea and edited the paper.

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