Brief teaching sessions change behaviour in A&E

Area of Science:

• Emergency Medicine
• Medical Education
• Radiology

Background:

• Accident and Emergency (A&E) departments are high-pressure environments demanding efficient teaching methods.
• New doctors often lack experience in managing cervical spine (c-spine) trauma.
• Effective, resource-light teaching strategies are crucial for improving clinical practice in A&E.

Purpose of the Study:

• To evaluate the impact of brief, multimodal teaching interventions on clinician behavior in managing c-spine trauma within A&E.
• To assess changes in the efficiency and appropriateness of c-spine computed tomography (CT) imaging following the teaching intervention.
• To determine if the teaching improved the adherence to clinical guidelines for c-spine CT scans.

Main Methods:

• A comparative study analyzing data from 482 patients undergoing c-spine CT in two A&E departments before and after a teaching intervention.
• Manual recording of key data points including time to CT, scan indication, and presence of bony injury from patient management software.
• Statistical analysis to compare outcomes pre- and post-intervention, focusing on scan frequency and timeliness.

Main Results:

• While the proportion of CT scans completed within one hour did not significantly change (31% to 37.6%), the weekly volume of c-spine CT scans increased significantly (14.50 to 23.25).
• The number of c-spine CT scans performed within one hour also rose significantly (4.50 to 8.75 per week).
• Scan quality, indicated by the detection of bony injury, remained consistent, and there was no increase in scans performed outside National Institute for Health and Care Excellence guidelines.

Conclusions:

• Brief, low-resource teaching interventions can effectively modify clinician behavior in A&E settings.
• The implemented teaching strategy was simple to deploy and shows potential for transferability to other guideline-driven diagnostic processes.
• Further research could explore outcomes in major trauma centers and analyze cases where CT scans were indicated but not performed.