Authors (including presenting author) :
Yuen MSY (1), Chan LW (1), Wong TYG (2), Kan WK (2), Pang KY (3), Kwok FY (1), Chan KC (1)
Affiliation :
(1) Department of Accident and Emergency, (2) Department of Radiology, (3), Department of Neurosurgery, Pamela Youde Nethersole Eastern Hospital
Introduction :
Introduction: Hundreds of patients attend Accident and Emergency Department daily in which ten to twenty presented with head injury. Management of minor head injury varies. Patients are often admitted for observation and computed tomography. Even with normal findings, admission remain normal practice because of risk of missing interpretation, delayed presentation, complication and medico legal issues. Early diagnosis and appropriate intervention improves outcomes. Early computed tomography can detect intracranial abnormality and reduce unnecessary hospital admission.
Objectives :
Objective: To report on implementation of improvement measures in A&E
Methodology :
Method: Review meeting of minor head injury management was held with Department of A&E, Radiology (DR) and Neurosurgery (NS) on November 2nd 2021; the practice of case management and risks were revised, multidisciplinary workflow was written. Patient with minor head injury (GCS 14 to 15) would trigger the workflow in A&E, where they would be admitted to observation ward for computed tomography (CT) and hourly neurological monitoring and cared by designated nursing staff, interpretation of findings would be done A&E Physician with the support of Neurosurgeon, intervention would be initiated. For patient with normal findings and stable vital signs and not living alone, would be discharged home with advice. Only those with positive findings or symptoms would be admitted to ward. To prepare for the above implementation, staff education was carried out. Radiographer arranged priority CT, A&E Physician and Neurosurgeon interpreted the CT films, A&E Nurse did the transfer and continuity of care, A&E Physician made clinical decision. Opinions were sought from clinical departments and handover mechanism of minor head injury cases enhanced. Barriers to implementation were overcome at the trial run period and prospective audit carried in the implementation period.
Result & Outcome :
Results: 199 presented with minor head injury attended A&E from November 8th 2021 to January 8th 2022, all fulfilled the criteria of minor head injury. 16 patients (8%) with positive CT findings and were admitted to NS ward, 183 patients (92%) presented with normal CT. Out of these 183 patients, 96 patients (48%) with stable vital signs were discharged home with advice, 87 patients (43%) presented with symptoms in which 81 opted for admission and 6 opted for DAMA. Out of the total of 199, there were 25 patients (12.5%) with A&E re-attendance within 28 days. The overall compliance to new workflow were 100%. Workload were regarded acceptable form staff surveys. Implementation was smooth and new measures were welcomed by patients and clinical departments. Conclusion: Through multidisciplinary collaboration, the improvement measures were feasible and results in significant improvement in management of minor head injury patients in A&E.
