To assess how the 2003 NICE guidelines about head‐injured patients are implemented at a large district general hospital, and how the existing shortfalls might be improved.
A six‐month audit was performed and the care of all head‐injured patients discharged or dying over a six‐month period was assessed in the following fields: admission criteria, number of responsible consultants, number of wards receiving patients, timing of transfer to specialist centres and CT scanning and skull X‐rays (SIGN guidelines were used for the latter as NICE currently recommends CT for all patients needing imaging), quality of neurological observations, criteria for re‐scanning, transfer for rehabilitation, advice and arrangements for follow‐up, and assignment of case managers.
Imaging rates were poor, observation timing was inadequate and discharge information or follow‐up arrangements were unsatisfactory. Care could be much improved by allowing one unit/ward and one firm to be in sole charge of head‐injured patients.
This case study provides practical advice for any busy hospital striving to maintain national standards in the care of head‐injured patients.
