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Adult Minor Head Injury CPI
Clinical scenario
Every year approximately 2 million people in the UK sustain a head injury. For many years there has controversy over the investigation and management of these patients. Since the advent of the NICE guidance and increased availability of CT scanning, there has been a dramatic reduction in the number of skull Xrays requested.
Audit question
Are adult minor head injury patients managed appropriately according to best practice (NICE) guidelines?
Method
Retrospective audit 50 consecutive Emergency Department patient records
Criteria
Inclusions: 50 adults coded as minor head injury
Exclusions: Exclude patients presenting GCS <15
Audits
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1st April 2009
Results
| Date | Patients | Measured | Results | Standard | Regional avg. |
|---|---|---|---|---|---|
| 01st April 2009 | Adult patients with head injury as their primary diagnosis. | Management of patients acording to the criteria. | Documented evidence of GCS | 100 % | 100 % |
| Documented evidence of presence or absence of history of loss of consciousness, amnesia and vomiting (all three required). | 100 % | 74 % | |||
| Documented evidence of assessment of bleeding risk (use of anticoagulation etc). | 100 % | 100 % | |||
| Documented mechanism of injury | 100 % | 100 % | |||
| Documented evidence of receiving head injury advice on discharge | 100 % | 50 % |
Comments
A mixed set of results. Improvements in the use of CT, however documentation issues and a query over timliness of intubation. However, sample size an issue, which is being addressed separately.
Audit Bottom Line
Small sample size of serious head injury patients an issue, however documentation of distribution of head injury advice requires work.