CT Time: A Vital Measurement in the Treatment of Moderate to Severe Head Injuries

Traumatic Brain Injury (TBI) is one of the most common types of injury seen by trauma centers. Many patients suffering from TBI die in the field before ever reaching a hospital. According to the American College of Surgeons (ACS) of all patients with TBI that do seek medical care, 25% can be classified as moderate to severe (2012). ACS also estimated that 1,700,000 TBIs occur annually, 250,000 patients are hospitalized, and 52,000 patients die. US data estimates 80,000 – 90,000 patients each year suffer a TBI with long-term disability. The primary goal in the care of TBI patients is to prevent secondary injury. Preventative measures include ensuring adequate oxygenation and maintaining adequate blood pressure to ensure perfusion of the brain. After stabilization of the ABCs, the goal is to rapidly identify a mass lesion that may require surgical intervention. This is achieved by obtaining a computerized tomographic (CT) scan of head. 

Some of the expected challenges for achieving our goal door-to-CT scan time included performing necessary lifesaving procedures prior to head CT scan, ensuring good team dynamics during initial patient arrival, and prompt transport of the patient for the head CT scan.  Other factors that were out of our control were radiology delays and delays due to physician discretion. Our team for gathering and reviewing data included two nurses and one physician.  Data was retrospectively gathered for 8 months prior to implementing any change.  This data was then shared with the nurses in the department as a whole and then on an individual basis.  Care was taken to emphasize this project was to improve our departments process and patient outcomes and in no way was being used a disciplinary tool.  Suggestions from staff were then gathered and best practices shared within the group.  As nurses began to understand the department goal and felt empowered to make decisions on delaying unnecessary procedures until after CT scan we began to see improvement.  In addition, nursing began thinking steps ahead and moving with more purpose. The ultimate goal was to improve patient outcomes and encourage nursing staff to be patient advocates for those presenting with head injuries