Neurocheck Frequency: Determining Perceptions and Barriers to Implementation of Evidence-Based Practice

Area of Science:

• Neurology
• Intensive Care Medicine
• Healthcare Quality Improvement

Background:

• Patients with acute brain injury in intensive care units (ICUs) often receive frequent neurological examinations ("neurochecks").
• These neurochecks, typically performed hourly or every-other-hour, aim to detect neurological deterioration.
• Provider attitudes and ideal frequencies for these critical assessments are not well understood.

Purpose of the Study:

• To assess healthcare provider attitudes regarding the frequency of neurochecks in the ICU.
• To evaluate the ideal frequency of neurochecks as perceived by healthcare providers.
• To identify discrepancies between ordering and performing providers' views on neurocheck protocols.

Main Methods:

• A cross-sectional online survey was conducted in Spring 2021 at a tertiary care academic medical center.
• Participants included attending faculty, medical trainees, advanced practice providers, and bedside nurses across ICU and neuroscience specialties.
• Survey data from 177 participants were analyzed to compare provider attitudes and preferences.

Main Results:

• Ordering providers viewed hourly neurochecks as potentially detrimental and expressed willingness to use alternative monitoring methods.
• Performing providers desired more prescriptive guidelines for neurocheck frequency and duration.
• A significant majority of both ordering and performing providers preferred every-other-hour neurochecks over hourly assessments.

Conclusions:

• Significant differences exist in the attitudes of ordering versus performing providers concerning frequent neurochecks.
• Both groups of providers indicated a preference for less frequent, every-other-hour neurochecks for patients with acute brain injury.
• Findings suggest a need to re-evaluate current neurocheck protocols to align with provider preferences and potentially improve patient care and workflow efficiency.