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

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.

THE CHANGING FACE OF ACUTE NEUROLOGY: EXPERIENCE FROM TWO DECADES OF THE CAMBRIDGE NEUROLOGY EMERGENCY CLINIC

Acute neurological presentations are a common problem, accounting for around 17% of GP consultations, 10% of A&E visits and around 20% of the medical take. There is an increasing appreciation of the need to reconfigure neurological services to meet this need, but the challenge is to provide a service for those who most need it with an under-resourced specialty. The Royal College of Physicians 2012 Consultant Physician Survey reported that there were 716 neurology consultants in the UK, resulting in 1 per 90,000 population, significantly lower than the recommended RCP minimum of 1 consultant per 70,000, every day of the week. One solution to the evident need is providing rapid access ambulatory pathways. Here we report on the Cambridge experience of nearly two decades provision of an emergency neurology clinic at Addenbrooke's Hospital. We show how the service has evolved and the changing patterns of presentation, management and outcomes of the patients seen. Annualised attendance data demonstrates increasing demand, whilst the proportion of patients presenting with headaches (now 40%) has escalated dramatically. By contrast, the number of patients referred with problems related to established chronic neurological diseases has fallen considerably, no doubt related to the development of specialist nurses and clinics.