Implementing the National Institute for Health and Clinical Excellence Head Injury 2014 Guidelines in a major children’s hospital emergency department

Ramjeeawon, Natalie; Lecky, Fiona; Burke, Derek; Ramlakhan, Shammi

doi:10.1097/mej.0000000000000512

Cited by 3 publications

(2 citation statements)

References 12 publications

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“…Stiell et al received similar answers regarding ED overcrowding that required more expedient care, possibly favouring a quicker but not entirely guideline-adherent approach [ 8 ]. An implementation study for the National Institute for Health and Care Excellence 2014 head injury guidelines showed a higher than expected percentage of early discharges from the ED, and the authors speculated that this could, at least partly, be attributed to ED overcrowding [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…The presence of guidelines in the work environment as a reminder of their existence and their intrinsic characteristics is also a factor that previous studies have either shown or speculated as actually or potentially beneficial to increase use. A workplace culture that emphasises guideline adherence through colleague encouragement and endorsement from the department management can also increase guideline adherence [ 17 – 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Ways to improve guideline adherence in the emergency department: an interview study on the management of traumatic brain injuries

Vestlund

Vedin

Edelhamre

et al. 2022

Eur J Trauma Emerg Surg

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Purpose The aim was to explore factors affecting guideline adherence among doctors in the emergency department and to explore the general perception about local guidelines for traumatic brain injuries. Methods Thirty semi-structured interviews were conducted with doctors with experience working in the emergency department regarding different aspects of guideline use, with emphasis on the management of traumatic brain injuries. Twenty-eight interviews were included for analysis. The interviews were recorded, transcribed, and analysed iteratively. Emergent codes were identified and organised into themes and subthemes. Results Eight themes were identified. Barriers were centred on low availability of local guidelines and guideline document design. Facilitating factors included a concise document, appropriate visual aids, high accessibility, and encouragement by management and senior peers. The local guidelines on traumatic brain injuries were regarded as distinct, but it was occasionally difficult to determine when they were applicable. Mandatory admission of patients on anticoagulants was sometimes perceived as excessive. Biomarker S100b was believed to sometimes lead to delayed care. Conclusion The participants believed that guideline adherence would increase by facilitating guideline availability, by providing concise, easy-to-understand, and well-illustrated guidelines available in printed form, as well as establishing a culture that promotes guideline use. The local guidelines for traumatic brain injuries were appreciated, but could be improved.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ways to improve guideline adherence in the emergency department: an interview study on the management of traumatic brain injuries

Vestlund

Vedin

Edelhamre

et al. 2022

Eur J Trauma Emerg Surg

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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

Pradhan

Shrestha

et al. 2021

PLoS ONE

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Introduction Head injury, a common presentation to the emergency department (ED), is a substantial problem in developing countries like Nepal. The current national institute for health and clinical excellence (NICE) guideline revised in January 2014 focuses on effective clinical assessment and early management of head injuries according to their severity in all age groups. This study assessed the impact of implementing this guideline on the proportions of computed tomography (CT) head scans, guideline adherence, and confidence level of the attending physicians. Methods We consecutively recruited 139 traumatic head injury (THI) patients in this prospective pre-post interventional study conducted in the ED of a tertiary care center. We implemented the NICE guideline into routine practice using multimodal intervention through physicians’ education sessions, information sheets and guideline-dissemination. The pre and post-implementation CT head scan rates were compared. The post-implementation guideline adherence was assessed. Online Google form-questionnaires including 12 validated case scenarios were distributed to the attending physicians at the end of both phases to assess their confidence levels. Results The implementation resulted in a statistically significant decrease in the proportion of CT head scan rates from 92.0% to 70.0% (p-value = 0.005). Following educational interventions, improved guideline adherence of 20.3 percentage points (p-value = 0.001) was observed. Nine ED attending physicians were enrolled in the study who showed statistically significant improvement in their confidence level following the intervention. The NICE guideline showed a sensitivity and specificity of 93.6% and 76.4% with 82.6% accuracy compared to that of clinical judgment (100%, 34.6%, and 58.1% respectively) in detecting intracranial lesions. Conclusion The implementation was successful in satisfying the aim of the NICE guideline by decreasing the proportion of CT head scans, improving guideline adherence and increasing the confidence of the attending physicians.

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Interventions to Reduce Imaging in Children With Minor Traumatic Head Injury: A Systematic Review

Lesyk,

Kirkland,

Villa-Roel

et al. 2024

Pediatrics

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CONTEXT: Reducing unnecessary imaging in emergency departments (EDs) for children with minor traumatic brain injuries (mTBIs) has been encouraged. OBJECTIVE: Our objective was to systematically review the effectiveness of interventions to decrease imaging in this population. DATA SOURCES: Eight electronic databases and the gray literature were searched. STUDY SELECTION: Comparative studies assessing ED interventions to reduce imaging in children with mTBIs were eligible. DATA EXTRACTION: Two independent reviewers screened studies, completed a quality assessment, and extracted data. The median of relative risks with interquartile range (IQR) are reported. A multivariable metaregression identified predictors of relative change in imaging. RESULTS: Twenty-eight studies were included, and most (79%) used before–after designs. The Pediatric Emergency Care Applied Research Network (PECARN) rule was the most common intervention (71%); most studies (75%) used multifaceted interventions (median components: 3; IQR: 1.75 to 4). Before–after studies assessing multi-faceted PECARN interventions reported decreased computed tomography (CT) head imaging (relative risk = 0.73; IQR: 0.60 to 0.89). Higher baseline imagine (P < .001) and additional intervention components (P = .008) were associated with larger imaging decreases. LIMITATIONS: The limitations of this study include the inconsistent reporting of important outcomes and that the results are based on non-randomized studies. CONCLUSIONS: Implementing interventions in EDs with high baseline CT ordering using complex interventions was more likely to reduce head imaging in children with mTBIs. Including the PECARN decision rule in the intervention strategy decreased orders by a median of 27%. Further research could provide insight into which specific factors influence successful implementation and sustained effects.

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Implementing the National Institute for Health and Clinical Excellence Head Injury 2014 Guidelines in a major children’s hospital emergency department

Cited by 3 publications

References 12 publications

Ways to improve guideline adherence in the emergency department: an interview study on the management of traumatic brain injuries

Ways to improve guideline adherence in the emergency department: an interview study on the management of traumatic brain injuries

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

Interventions to Reduce Imaging in Children With Minor Traumatic Head Injury: A Systematic Review

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