# Evaluating Adherence to 2023 National Institute for Health and Care Excellence (NICE) Guidelines for Computed Tomography (CT) Scans in Head Injury Presentations at University Hospital of North Durham in England, UK: A Quality Improvement Project

## TL;DR

This study shows that education and visible guidelines improved adherence to CT scan guidelines for head injuries in a UK hospital.

## Contribution

Demonstrates effectiveness of education and visibility in improving compliance with NICE CT scan guidelines for head injuries.

## Key findings

- Compliance with NICE guidelines improved from 78.4% to 88.5% after interventions.
- CT scans for high-risk patients within one hour increased from 40% to 61.1%.
- Education and visible guidelines were key factors in improved adherence.

## Abstract

Introduction

Traumatic brain injury (TBI) remains a major public health concern in the United Kingdom, with computed tomography (CT) head imaging essential for the early detection of intracranial injury. This study aimed to evaluate local compliance with the National Institute for Health and Care Excellence (NICE) criteria at University Hospital of North Durham and assess whether education-based intervention could improve adherence to national standards.

Methods

This quality improvement study was conducted in two cycles during the year 2023-2024 in our emergency department. Adult patients (aged ≥16 years) undergoing CT head scans for traumatic head injury were retrospectively reviewed. In the first cycle, baseline adherence to NICE criteria was assessed. After the data was analysed, targeted interventions were introduced, including structured teaching for doctors and nurses, visible posting of CT criteria in key clinical areas, as well as increased senior clinician oversight in triage and handover points. The second cycle evaluated post-intervention compliance using the same methodology. Data included clinical indications, documented risk factors, and timing of imaging. Statistical analysis compared the performance between the two cycles.

Results

Overall compliance with NICE guidelines improved from 29 (78.4%) of 37 patients in the first cycle to 46 (88.5%) of 52 in the second cycle. For high-risk patients, CT completion within one hour increased from 4/10 (40%) to 11/18 (61.1%). For patients on anticoagulation, compliance remained consistently high at 100% in both cycles. For patients with amnesia or loss of consciousness, imaging within eight hours improved from 6/9 (66.7%) to 22/28 (78.6%). These improvements were largely attributed to increased awareness, education, and better early identification of high-risk cases following intervention.

Conclusion

This study demonstrated that targeted interventions, such as staff education, visible guidelines, and senior oversight, improved compliance with NICE CT head guidelines for patients with head injury. Sustained changes in clinical practice can enhance patient safety and support more efficient emergency care.