Computer Tomography (CT) for head injury: adherence to the National Institute for Health and Care Excellence (NICE) criteria

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.

Impact of implementation of the national institute for health and clinical excellence (NICE) head injury guideline in a tertiary care center emergency department: A pre and post-intervention study

“…Following interventions for quality improvement to adhere to the NICE guideline in a study [27], there was a statistically significant decrease of 23.0 percentage points in the number of CT heads requested with no clear indication following intervention (p = 0.00027) which was similar to our results (20.3%, p = 0.001). This reduction in unnecessary CT head scans may result in considerable savings to numerous families while ensuring access for those really in need.…”

“…The result is contradictory in various previous studies [21]. Correspondingly there have been studies [26,27] showing a similar decrement in the proportion of CT head scans performed following the implementation of the NICE guideline. A previous study [22] showed that the proportion of CT head scans performed decreased by a lesser rate than our study, from 40 (4.8%) to 23 (2.4%) and the proportion of CT head scans performed without indication decreased from 14 (1.7%) to 4 (0.4%).…”

“…The study by Mooney et al [26] showed compliance of 94.2% pre-implementation of NICE guideline which increased to 98.8% post-guideline implementation in adults. The studies by Harris et al [27] and Dhungana et al [17] also concluded that the adherence to the NICE guideline could be improved by interventions such as an educational program to the trauma team of the hospital, a repeated survey of the attending physicians and their feedback.…”

Door-to-Skin Time in Patient Undergoing Emergency Trauma Craniotomy

“…The probable cause for this finding is the physical distance to the CT machine, which is located in a radiology suite away from the ED at HSAJB. In the literature, the door-to-CT time ranges from 45.6 min to 2 h ( 19 , 22 , 23 ). Simple interventions, including education sessions for the multidisciplinary team and junior doctors and distribution of information sheets on prevailing guidelines, have been shown to reduce the mean time to scan from 73 to 55 min ( 23 ).…”

“…In the literature, the door-to-CT time ranges from 45.6 min to 2 h ( 19 , 22 , 23 ). Simple interventions, including education sessions for the multidisciplinary team and junior doctors and distribution of information sheets on prevailing guidelines, have been shown to reduce the mean time to scan from 73 to 55 min ( 23 ). In another study involving patients with acute stroke, the door-to-CT time of within 20 min increased from 47% to 74% when the CT scanner was relocated within the ED ( 24 ).…”