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Management of Traumatic Brain Injury in the Emergency Department : Guideline Adherence and Patient Safety

Vedin, Tomas LU ; Edelhamre, Marcus LU ; Karlsson, Mathias; Bergenheim, Michael and Larsson, Per Anders LU (2017) In Quality Management in Health Care 26(4). p.190-195
Abstract

Background: Traumatic brain injury is a common reason not only for emergency visits worldwide but also for significant morbidity and mortality. Several clinical guidelines exist but adherence is generally low. Aim: To study attitudes toward computed tomography of the head among emergency department Change to physicians throughout the article who manage patients with trauma to the head and doctors' adherence to guidelines. Methods: Quantitative questionnaire study with questionnaires collected over 3 months before introduction of new guidelines. After introduction, intermission of 8 months passed when information and education were given. Thereafter, questionnaires were collected for another 3 months. Results: A total of 694 patients... (More)

Background: Traumatic brain injury is a common reason not only for emergency visits worldwide but also for significant morbidity and mortality. Several clinical guidelines exist but adherence is generally low. Aim: To study attitudes toward computed tomography of the head among emergency department Change to physicians throughout the article who manage patients with trauma to the head and doctors' adherence to guidelines. Methods: Quantitative questionnaire study with questionnaires collected over 3 months before introduction of new guidelines. After introduction, intermission of 8 months passed when information and education were given. Thereafter, questionnaires were collected for another 3 months. Results: A total of 694 patients were registered at the emergency department. A total of 161 questionnaires were analyzed; 50.9% did not use guidelines, 39% before intermission, and 60.5% after. When Canadian CT Head Rule was applied, 30.4% of patients with no loss of consciousness were referred to computed tomography, violating guideline recommendation. Conclusion: Guidelines are designed to improve performance but are not always applied correctly or as frequently as intended. Information and education did not increase guideline adherence. To improve guideline adherence, more innovative measures than formal guidelines must be undertaken. To find out what these measures are, we suggest qualitative studies to elucidate interventions that will have bigger impact on performance.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
CT scan, guideline adherence, guidelines, surveys and questionnaires, traumatic brain injury, X-ray
in
Quality Management in Health Care
volume
26
issue
4
pages
6 pages
publisher
Lippincott Williams and Wilkins Ltd.
external identifiers
  • scopus:85031322611
ISSN
1063-8628
DOI
10.1097/QMH.0000000000000151
language
English
LU publication?
yes
id
89fc33db-c743-4c57-8a03-d4a1d741a4a9
date added to LUP
2017-11-07 15:03:18
date last changed
2018-01-07 12:25:15
@article{89fc33db-c743-4c57-8a03-d4a1d741a4a9,
  abstract     = {<p>Background: Traumatic brain injury is a common reason not only for emergency visits worldwide but also for significant morbidity and mortality. Several clinical guidelines exist but adherence is generally low. Aim: To study attitudes toward computed tomography of the head among emergency department Change to physicians throughout the article who manage patients with trauma to the head and doctors' adherence to guidelines. Methods: Quantitative questionnaire study with questionnaires collected over 3 months before introduction of new guidelines. After introduction, intermission of 8 months passed when information and education were given. Thereafter, questionnaires were collected for another 3 months. Results: A total of 694 patients were registered at the emergency department. A total of 161 questionnaires were analyzed; 50.9% did not use guidelines, 39% before intermission, and 60.5% after. When Canadian CT Head Rule was applied, 30.4% of patients with no loss of consciousness were referred to computed tomography, violating guideline recommendation. Conclusion: Guidelines are designed to improve performance but are not always applied correctly or as frequently as intended. Information and education did not increase guideline adherence. To improve guideline adherence, more innovative measures than formal guidelines must be undertaken. To find out what these measures are, we suggest qualitative studies to elucidate interventions that will have bigger impact on performance.</p>},
  author       = {Vedin, Tomas and Edelhamre, Marcus and Karlsson, Mathias and Bergenheim, Michael and Larsson, Per Anders},
  issn         = {1063-8628},
  keyword      = {CT scan,guideline adherence,guidelines,surveys and questionnaires,traumatic brain injury,X-ray},
  language     = {eng},
  number       = {4},
  pages        = {190--195},
  publisher    = {Lippincott Williams and Wilkins Ltd.},
  series       = {Quality Management in Health Care},
  title        = {Management of Traumatic Brain Injury in the Emergency Department : Guideline Adherence and Patient Safety},
  url          = {http://dx.doi.org/10.1097/QMH.0000000000000151},
  volume       = {26},
  year         = {2017},
}