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Short report
Head home: implementation during COVID-19 pandemic
  1. Patrick Aldridge1,
  2. Rachel Parish2,
  3. Heather Castle1,
  4. Emma Russell1,
  5. Raj Rout3,
  6. Roohi Singh4
  1. 1 Paediatric Emergency Department, Frimley Park Hospital NHS Foundation Trust, Frimley, UK
  2. 2 Emergency Department, Frimley Park Hospital NHS Foundation Trust, Frimley, Surrey, UK
  3. 3 Global Medical Affairs, Sanofi Genzyme, Guildford, UK
  4. 4 University of East Anglia Norwich Medical School, Norwich, Norfolk, UK
  1. Correspondence to Dr Patrick Aldridge, Paediatric Emergency Department, Frimley Park Hospital NHS Foundation Trust, Frimley GU16 7UJ, UK; patrickjaldridge{at}hotmail.com

Abstract

Background Recent research suggests that between 20% and 50% of paediatric head injuries attending our emergency department (ED) could be safely discharged soon after triage, without the need for medical review, using a ‘Head Injury Discharge At Triage’ tool (HIDAT). We sought to implement this into clinical practice.

Methods Paediatric ED triage staff underwent competency-based assessments for HIDAT with all head injury presentations 1 May to 31 October 2020 included in analysis. We determined which patients were discharged using the tool, which underwent CT of the brain and whether there was a clinically important traumatic brain injury or representation to the ED.

Results Of the 1429 patients screened; 610 (43%) screened negative with 250 (18%) discharged by nursing staff. Of the entire cohort, 32 CTs were performed for head injury concerns (6 abnormal) with 1 CT performed in the HIDAT negative group (normal). Of those discharged using HIDAT, four reattended, two with vomiting (no imaging or admission) and two with minor scalp wound infections. Two patients who screened negative declined discharge under the policy with later medical discharge (no imaging or admission). Paediatric ED attendances were 29% lower than in 2018.

Conclusion We have successfully implemented HIDAT into local clinical practice. The number discharged (18%) is lower than originally described; this is likely multifactorial. The relationship between COVID-19 and paediatric ED attendances is unclear but decreased attendances suggest those for whom the tool was originally designed are not attending ED and may be accessing other medical/non-medical resources

  • trauma
  • head
  • emergency care systems
  • paediatric emergency med
  • paediatric injury
  • performance improvement

Data availability statement

Data is available on reasonable request.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/emermed-2020-211007

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    Data availability statement

    Data is available on reasonable request.

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    Footnotes

    • Handling editor Mary Dawood

    • Contributors PA is the overall guarantor who planned, conducted and reported the study. RP planned, conducted and reported the study. HC, ER, RR and RS planned and reported the study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.