# CT Head Imaging Within 60 Minutes of Arrival at the ED: A Clinical Audit

## TL;DR

This audit evaluated how quickly patients in an emergency department received CT head scans and found that a new triage tool improved compliance with guidelines.

## Contribution

The study introduces a triage pro forma to improve timely CT head imaging in emergency departments.

## Key findings

- Only 4.34% of patients received CT imaging within 60 minutes before the intervention.
- The triage pro forma increased compliance to 6.9%, a statistically significant improvement.
- Staff compliance and workload remain challenges for broader implementation.

## Abstract

Objective

This audit aimed to assess current compliance with the National Institute for Health and Care Excellence (NICE) NG232 guideline and evaluate the impact of introducing a triage pro forma to nurses to improve the time from patients’ arrival in the Emergency Department (ED) to CT head imaging in eligible patients.

Method

A retrospective clinical audit was conducted over two cycles at the ED of a UK District General Hospital. It included patients at the ED who underwent CT head imaging. Non-trauma-related indications and patients under the age of 16 years were excluded. The first cycle, using Electronic Patient Records (EPR), reviewed 138 patients from 20 September 2023 to 20 October 2023. A pro forma was then introduced to assist triage nurses in identifying eligible patients, ensuring they were promptly assessed by a clinician, and imaging was requested. Daily educational sessions were conducted from 20 October 2023 to 3 November 2023, along with email dissemination and handover reinforcement. The second cycle was conducted from 3 November 2023 to 15 November 2023 and included 87 patients, with their data collected from EPR.

Results

In the first cycle, 4.34% (n=6) of patients received imaging within 60 minutes, which is suboptimal. In the second cycle, the proportion of imaging completed within 60 minutes increased to 6.9% (n=6), and this incremental increase is significant (p <0.05).

Conclusion

The introduction of the triage pro forma resulted in incremental improvements in timely brain imaging, and, therefore, the intervention showed significant positive potential in enhancing adherence to national guidelines and improving patient outcomes. Challenges such as staff compliance, patient transfer time, and workload do influence this, and those are areas that need further improvement. This project has the potential to be implemented across multiple trusts.