# Digitally Enabled Discharge Quality After Neurosurgical Traumatic Brain Injury: A 10-Year Cohort from a Brazilian Public Tertiary Center

## TL;DR

This study finds that counseling for warning signs after neurosurgical TBI discharges is poorly documented in a Brazilian hospital, suggesting digital tools could improve discharge quality.

## Contribution

The study identifies digitally actionable gaps in discharge processes for neurosurgical TBI patients in a resource-constrained setting.

## Key findings

- Warning sign counseling was documented in only 16.1% of discharges.
- No palliative care referrals were recorded in the 10-year cohort.
- Digital interventions like EHR order sets and QR-coded handouts are proposed to improve discharge quality.

## Abstract

What are the main findings?
In a 10-year cohort of 559 neursurgical TBI discharges at a Brazilian public tertiary center, warning sign counseling was documented in 16.1% (95% CI 13.2–19.5) and palliative care referrals were 0%.EHR documentation exposed specific, digitally fixable gaps in the discharge process that can be measured as process quality indicators.

In a 10-year cohort of 559 neur

surgical TBI discharges at a Brazilian public tertiary center, warning sign counseling was documented in 16.1% (95% CI 13.2–19.5) and palliative care referrals were 0%.

EHR documentation exposed specific, digitally fixable gaps in the discharge process that can be measured as process quality indicators.

What are the implications of the main findings?
EHR discharge order sets with mandatory fields, CDS prompts for palliative care screening, and QR-coded patient handouts can standardize counseling and trigger appropriate referrals.The low, precisely estimated baseline provides a pragmatic target for quality improvement and a monitorable metric for resource-constrained hospitals.

EHR discharge order sets with mandatory fields, CDS prompts for palliative care screening, and QR-coded patient handouts can standardize counseling and trigger appropriate referrals.

The low, precisely estimated baseline provides a pragmatic target for quality improvement and a monitorable metric for resource-constrained hospitals.

Background/Objectives: Safe discharge after neurosurgical traumatic brain injury (TBI) depends on documented counseling and appropriate referrals, yet real-world fidelity is uncertain in resource-constrained settings. We quantified discharge process quality and identified digitally actionable gaps. Methods: The sample for this study was a retrospective cohort of 559 consecutive neurosurgical TBI patients discharged from a Brazilian public tertiary center (2012–2022). Data were abstracted from electronic health records. The primary outcome was documentation of warning sign counseling at discharge. Proportions are reported with exact Clopper–Pearson 95% confidence intervals. Results: The median age was 66 years (IQR 47–79.5); 78.5% were male and most received care under the public health system. Subdural hematoma predominated; hematoma drainage was the most frequent procedure. Warning sign counseling was documented in 16.1% of cases (89/559; 95% CI 13.2–19.5), and no palliative care referrals were recorded. Conclusions: A low baseline for a safety-critical discharge element exposes an immediately actionable target. Embedding discharge order sets with mandatory counseling fields in the EHR, clinical decision support prompts for palliative care screening and follow-up, and QR-coded patient handouts represent a pragmatic path to improve discharge quality and end-of-life readiness in the digital era.