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Audit of Head Injury

The Audit, Information and Analysis Unit have completed two pilot projects reviewing the management of head injuries in Trusts in Kent and Medway and South East London.

Phase I focused on quantifying the number of patients with a head injury who attended Accident & Emergency, the number of patients admitted with a head injury and the level of severity and compliance against NICE guidance for imaging and triage. Phase II aimed to review patients that presented with a moderate or severe head injury.

The Phase I audit was carried out over 6 weeks in 11 Trusts. During this time 3,184 patients attended A&E with a head injury. A total of 373 of these patients were admitted to hospital or transferred to a neurosurgical centre. 8 patients were classified as having a severe head injury and 15 were classified as moderate. 13 of the 373 patients were transferred to the neurosurgical centre,

The Phase II audit was carried out over a 4 month period in 11 Trusts. 65 questionnaires were completed by District General Hospitals, but only 52 patients were eligible for inclusion in the audit as some patients did not have a moderate or severe head injury. The neurosurgical centre identified 62 patients that were referred / admitted during the 4 month period. 43/62 patients were excluded of these 27 did not have a severe or moderate head injury. Overall 19 patients met the audit criteria.

The results of the two audits showed that there were opportunities for improvement in terms of compliance with the NICE guidelines. There was also a need to understand the issues related to patient transfer, capacity and delays in repatriating patients from the neurosurgical centre.                    

Some of the recommendations do not require additional resources and could be implemented immediately. Others do have resource implications and need to be properly planned. Some of the areas for immediate improvement in District General Hospitals include the need to:

  • Develop and implement local transfer protocols between Trusts, the Neurosciences Centre and the Ambulance Services
  • Have a designated Consultant with responsibility for the transfer of patients to a Neurosurgical Centre and clarity about what level of doctor should accompany a patient.
  • Consult with neurosurgery centres about managing head injury patients.
  • Carry out and record the results of the Glasgow Coma Score assessment in patient notes.
  •     Risk assess all head injury patients for brain and cervical spine imaging.
  • Patients and carers must be made aware of services that they can access in the event of long-term problems.

 The areas that have resource implications and need to be planned include a:

  • Review of Neuro Critical Care capacity for the King’s catchment area and potentially for the South East.
  • Review of the factors affecting the repatriation of patients that no longer need tertiary neurosurgical care.

Further details about both studies can be obtained from:

Maria Yeomans
Head, Audit Information & Analysis Unit
East of England, London & South East Coast SCGs
Telephone:     01323 747742
Mobile:           07904577193
nww.esussexaiau.nhs.uk

Background

 The Audit, Information & Analysis Unit (AIAU) is supported by 48 PCTs in Essex, Beds, Herts, London, Kent, Surrey and Sussex. The Unit is accountable to the East of England, London and South East Coast Specialised Commissioning Groups.